The Netherlands' first endowed dietetics professor, Marian de van der Schueren, delivered her speech at Wageningen University & Research on Thursday. What she mainly wants to do in her chair is collect practical evidence about what approaches to healthy living, work well for specific individuals, groups and diseases: evidence-based dietetics. How can guidelines on healthy nutrition be tailored to individuals and to people with underlying ailments and diseases?
With her chair, the new professor will make the link between knowledge about nutrition and health, nutrition and disease, and practice. “Paramedical care, including dietetics, is developing rapidly,” she says. “Lifestyle will only become more important. Scientific knowledge and research from Wageningen can contribute to a better basis for the work of dieticians. In 2018, research agendas were drawn up for five paramedical professional groups, identifying gaps in knowledge. That is the direct reason for this chair.”
Why is it “high time” right now? “Half of the Dutch population is overweight, the elderly are living at home longer, and the pandemic has revealed the poor state of our lifestyle,” she says. “Nutrition plays a big role in all this. Weight problems and cardiovascular disease are largely associated with poor nutrition. Diabetes can be reversed. Recovery from illness can be accelerated. And in all these things, a person-centred approach is very important. What works for specific groups of people? That is what we have to find out.”
That sounds like applied science. “It is. We want to gather evidence from practice about what really works, together with dieticians and patients. Scientific research — including research conducted at Wageningen — is usually carried out very thoroughly, under controlled conditions. For example, participants are given meals by the university. But are these interventions still effective in everyday practice? We will be investigating this over the coming years. Dietetics also looks beyond the general guidelines. That means from healthy nutrition (about which there is a lot of knowledge in Wageningen) to adapted food.”
Cooperation with chairs
What does that look like in concrete terms in Wageningen? De van der Schueren explains that it means doing research with the target group. “For example, there is currently a study on the balance between healthy nutrition and quality of life under way in nursing homes that is being conducted by a mix of HBO (higher vocational education) and WO (scientific research) students. The Wageningen students have told me unanimously that by working in practice, they understand better why things work or don't work and how to collect data on that. ‘We know the theory, but not the practice,’ they say.”
Another example is a randomised trial currently under way on the role of lifestyle intervention in limiting cognitive decline. “Here we look at nutrition, exercise, sleep, and stress, among other things. We look at all factors, basically. One group follows the basic recommendations of the Health Council; the other follows a personalised approach. Wageningen University & Research provides the nutritional knowledge for this.”
Van der Schueren works together with various chair groups, including that of Ellen Kampman. “Dietetics is not yet sufficiently embedded in research on nutrition and cancer. How can you make the nutritional intake feasible and acceptable for the patient? This is also where Emely de Vet comes in. We may want clients to change their behaviour, but do they themselves want to? Is there awareness and motivation? Nutritional goals can be achieved via different routes: what is the best way? Another example of this issue is eHealth. Do people want to use an app or does that actually not work?”
Another area that the new professor is focusing on is nutrition in old age. Lisette de Groot's chair group will be closely involved in this. “The Health Council recommends a certain protein intake. Except, that figure is for healthy Dutch people. What about the sick and the elderly? This is where dietetics comes in again. It is also interesting to look at protein from the perspective of Wageningen's sustainability expertise. We want to move more in the direction of plant-based food, so what does that mean for nutritional recommendations?”
“A dietician’s work must be methodical”
Then you have the dieticians themselves. De van der Schueren says that the quality of their work is usually good, but it has to be methodical. She is also going to work on that. “If dieticians collect their data in a good, standardised manner, Wageningen can make use of it. Not every dietician needs to become a research associate. However, every dietitian can contribute the necessary data to provide a greater scientific basis for the profession. The power of dieticians is to work in a personalised way. They often make that decision based on experience and less on evidence. We want to combine these experiences and back them up with evidence. That way, we can help the field progress.”
Six PhD students have already joined the new professor. Furthermore, De van der Schueren will introduce dietetics and adapted nutrition in the case of illness into existing courses in the Bachelor’s and Master’s programmes. “Within the HBO dietetics programme, we want to pay more attention to the research subjects. This ensures that there will be greater dynamics and connection between the study programmes.” In her speech, she talks about a “golden combination”.