Nutrition during metabolic stress

Metabolic stress, a phenomenon that disrupts the metabolic processes in the body, occurs during acute or chronic illness such as during Intensive Care Unit (ICU) stay, disease or surgery. Severe metabolic stress from a serious illness can be compared to the extreme physical stress in professional sports. As a result of this stress, metabolic complications including severe muscle wasting, glucose disturbance, increased inflammation and gastrointestinal dysfunction can impair recovery and persist after hospital discharge. This can lead to years of chronic health problems, such as severe fatigue and loss of strength, difficulty with concentration, memory loss or depression.

Our research focusses on the role of (clinical) nutrition and exercise both during acute illness as well as in the period after recovery from metabolic stress. We aim to understand to what extend nutrition can play a role to attenuate metabolic complications, improve clinical outcomes after ICU discharge, and unravel why some patients recover fully from a life-threatening physical situation and others do not. We initiate and participate in international multicenter studies as well as single-centre trials and combine retrospective and prospective cohort studies with mechanistic studies and clinical intervention studies to further understand the role of nutrition during metabolic stress.

In this research line, we link with specialised care in the area of critical care medicine, surgery, geriatrics, medical physiology, dietetics, and sports medicine at Gelderse Vallei Hospital, Rijnstate hospital, and Utrecht Medical Centre through the Nutrition in Healthcare Alliance. Through research and innovation, this Alliance translates scientific insights about nutrition into person-oriented prevention and care. To achieve this, the Alliance brings together science, healthcare practice, government agencies and public bodies and industry.

The pathophysiology of chronic diseases, particularly those associated with aging, often includes muscle wasting, a condition characterized by the loss of muscle mass and function. This research line investigates the mechanisms underlying muscle loss, such as those occurring in cancer-associated cachexia, and how altered communication between the gut, brain, and immune system contributes to this process. Specifically, we explore how gut permeability and hypothalamic inflammation influence systemic inflammation, further exacerbating muscle wasting. Our studies indicate that increased intestinal permeability allows gut-derived pro-inflammatory substances to enter circulation, enhancing hypothalamic inflammation and leading to a broader inflammatory response that contributes to the decline in muscle health and overall physical function in chronic diseases.

This research topics investigates micronutrient status in patients with chronic wounds. Micronutrients play critical roles in various aspects of tissue repair and regeneration, such as cell proliferation (B-vitamins), collagen formation (vitamin C), or regulation of oxidative stress (vitamins A and E). In clinical practice however, biomarkers of vitamin status are however barely investigated. This topic addresses a knowledge gap in this area. In addition, personalized tools (NutriProfiel®) to improve micronutrient intake and status in clinical settings are developed and implemented together with Hospital Gelderse Vallei.

This research topic addresses the interplay between nutrition and physical activity in order to optimize health benefits, or affect performance and recovery. Target group ranges from patients and persons with a sedentary lifestyle to recreationally-active and elite athletes. Main focus is on exercise and cardiorespiratory fitness, with emphasis is on the role of carbohydrate and protein in the adaptive response to exercise, (micro)nutrient intake and status in athletes, and the effect of exercise on gut health and the immune system. In addition, nutrition is increasingly recognised as a supportive strategy to accelerate recovery after an injury like tendinopathy or ACL reconstruction