Good recovery from illness, meaningful healthcare: Priority areas for new professor Van Zanten

From his office at Gelderse Vallei Hospital, Van Zanten tells us that it is a little quieter in the ICU at the moment. In spite of the pandemic, he initiated several studies and started lecturing at WUR. He has really been enjoying it so far. “My appointment means that links can be made between research and hospital practice. I have noticed the benefit of linking research directly to interventions in the hospital.” The chair is funded by Gelderse Vallei hospital. His studies fall under the Metabolic Stress research line of the Alliantie Voeding in de Zorg (food in healthcare alliance).

Van Zanten knows the ICU inside out. “As a result of developments in the past decades, chances are improving that someone will survive the ICU. That improvement is great, but I also notice new problems developing. Time spent in ICU takes a toll on your body. “You lose a lot of muscle mass, up to one kilogramme a day. When you survive, you are recovering from a situation in which, from a biological standpoint, you should not be alive anymore - this is how much the body has weakened. That is why long-term physical and psychological symptoms arise. Some of the patients also suffer from accelerated dementia and loss of IQ.”

Studies show that some patients get stronger after six months, but that another group lags behind. The reasons for this have not been sufficiently researched yet. “It is often hard to pinpoint a reason. Some healthy marathon runners recover badly from the ICU, while people with weaker overall health sometimes recover well. I want to know the underlying reason. This is why we have to find out what exactly happens in the muscles and cells during admission to the ICU and how this is impacted by nutrition. Because of the opportunity I have been given, we are finding out more and more about it.”

Importance of nutrition on the map

Among other things, the new professor is looking at the importance of administering micronutrients, such as vitamins and trace elements, in the ICU. “Protein is also very important for building muscle. However, we have noticed that we should not administer too much protein in the first three days of admission. That was a surprising finding. We think that the metabolism cannot properly handle such nutrients at the start of an ICU admission. We have just started a randomised controlled trial (RCT). In this study, patients will receive an additional 40 grams of protein or 40 grams of carbohydrates every day for six weeks from the day they arrive in the ICU. We hope to demonstrate that the administration of protein in those weeks leads to a better functional result and quality of life.”

There is a good reason that “Let food be thy medicine, and medicine be thy food” is the title of Van Zanten’s inaugural lecture. “In many hospitals, formulas that assume an average requirement for protein and energy are used in the Intensive Care Unit. Great strides can still be made here towards more personalised nutrition. Checking a patient's individual nutritional requirement should be routine, just like administering a thrombosis shot. However, many healthcare professionals are not sufficiently trained in this area. There is not enough knowledge available yet either: we want to provide it.”

Variety of studies and collaborations

Van Zanten is collaborating with seven PhD candidates: two from Utrecht, five from Wageningen. In addition to the RCT, research is being conducted into refeeding syndrome (after a period of starvation due to illness), the removal of feeding tubes (that are removed too quickly), and the microbiome. Furthermore, an electronic system that measures nutritional intake has been developed at the hospital. Together with Jaap Keijer’s group, from Human and Animal Physiology, he is conducting research into whether something could be amiss with the energy metabolism in the mitochondria (the powerhouse of the cell).

There is a lot of nutrition research available at Wageningen University & Research. “The new thing is that we are looking at how hospital patients respond to nutrition and why. Furthermore, there is already a lot of attention for disease and prevention, but less for secondary prevention and recovery: how do you make sure that a patient really recovers and what role does nutrition play in this? Healthcare should not stop after the ICU.” The research also intersects with other fields such as oncology and food intake in sports. “Sometimes, a person is no longer able to undergo a full oncological treatment because they are underweight. If we have a better idea of who can tolerate what nutrition and when, then their weight can improve and they will be able to endure the full treatment.

There are also ongoing collaborations with Maastricht University that include biopsies from the muscles of ICU patients to determine how much protein can be produced by the muscles and with the Karolinska Institute in Stockholm, where research is being conducted into autophagy, the cleaning mechanism of cells.

“Meaningful healthcare and good recovery”

All this research touches on the “patient journey”, as Van Zanten calls it. How do patients arrive? How are they leaving? How healthy will they remain? “The ageing population and shortage of healthcare staff make it essential that we work on this. It is important to create well-functioning survivors in the ICU. This is why the focus should be moved to meaningful healthcare and the importance of a good recovery. The more research we have about this, the better we will be able to identify options for recovery as well. This will also enable us to enter into better-informed discussions with a patient when we notice that this recovery is no longer possible.

Van Zanten feels that he has a bridging role in this. “I can now serve both the medical and the academic world. This is why I experience it as a very valuable collaboration. I see it as a fresh start to expand on this topic and put it on the agenda together with Wageningen University & Research.”