Background & aims: Optimal nutritional support during the acute phase of critical illness remains controversial. We hypothesized that patients with low skeletal muscle area and -density may specifically benefit from early high protein intake. Aim of the present study was to determine the association between early protein intake (day 2–4) and mortality in critically ill intensive care unit (ICU) patients with normal skeletal muscle area, low skeletal muscle area, or combined low skeletal muscle area and -density. Methods: Retrospective database study in mechanically ventilated, adult critically ill patients with an abdominal CT-scan suitable for skeletal muscle assessment around ICU admission, admitted from January 2004 to January 2016 (n = 739). Patients received protocolized nutrition with protein target 1.2–1.5 g/kg/day. Skeletal muscle area and -density were assessed on abdominal CT-scans at the 3rd lumbar vertebra level using previously defined cut-offs. Results: Of 739 included patients (mean age 58 years, 483 male (65%), APACHE II score 23), 294 (40%) were admitted with normal skeletal muscle area and 445 (60%) with low skeletal muscle area. Two hundred (45% of the low skeletal muscle area group) had combined low skeletal muscle area and -density. In the normal skeletal muscle area group, no significant associations were found. In the low skeletal muscle area group, higher early protein intake was associated with lower 60-day mortality (adjusted hazard ratio (HR) per 0.1 g/kg/day 0.82, 95%CI 0.73–0.94) and lower 6-month mortality (HR 0.88, 95%CI 0.79–0.98). Similar associations were found in the combined low skeletal muscle area and -density subgroup (HR 0.76, 95%CI 0.64–0.90 for 60-day mortality and HR 0.80, 95%CI 0.68–0.93 for 6-month mortality). Conclusions: Early high protein intake is associated with lower mortality in critically ill patients with low skeletal muscle area and -density, but not in patients with normal skeletal muscle area on admission. These findings may be a further step to personalized nutrition, although randomized studies are needed to assess causality.
Amsterdam faces the challenge of accommodating 50,000 to 90,000 new homes in the next five to ten years. That is equivalent to 10% of the city’s current total housing stock. The new homes have to be built within the existing urban fabric. This will entail high densities and the construction of new ‘un-Dutch’ typologies with high-rise residential buildings. Densification is currently accelerating in many Western cities and high-rise living environments are gaining ground as today’s typology. Yet these new typologies come with potentially serious risks to the liveability of cities in general and those new environments in particular (Asgarzadeh et al. 2012; Lindal and Hartig 2013; Gifford 2007). Urban designers and (landscape) architects are challenged to prevent and soften the negative impact that is often associated with extremely densified environments. This entails mitigating contradictive demands: to create high-density capacity andshape streetscapes that relate to a human scale. Designers might resort to the large body of applied design solutions and theories, yet these tend to be derived from more traditional urban fabrics of low-density developments (for example: e.g. Sennett 2018; Haas 2008; Jacobs 1993; Banerjee and Southworth 1990; Alexander et.al. 1977; Jacobs 1961).Therefore, the question of the research project Sensing Streetscape is if the classical design solutions are without any alterations, applicable in these new high density settings and able to create streetscapes with a human scale. A combination of emerging technologies and principles from both worlds; neuroscience and architecture offer the opportunity to investigate this question in-depth as a relation between the designed and the visually perceived streetscape.
