Fuel and function: nutrition and physical activity in people at risk of or with dysvascular major lower limb amputation
Fuel and function: nutrition and physical activity in people at risk of or with dysvascular major lower limb amputation
People with chronic limb-threatening ischemia (CLTI) or who have undergone dysvascular major lower limb amputation (LLA) face high risks of impaired wound healing, reduced physical functioning, lower quality of life, and mortality. This thesis of Aniek Kolen aimed to gain insight into the role of two modifiable factors: (under)nutrition and physical activity, to potentially optimize patient and clinical outcomes in people with CLTI or dysvascular major LLA.
Undernutrition was found to be highly prevalent shortly after amputation and months later. Many participants had weight loss, inadequate nutritional intake, nutrition impact symptoms, limitations in activities/functioning, and low grip strength and muscle mass. Undernutrition was associated with lower quality of life, reduced mobility, and less reamputation-free survival. Remarkably, all participants who died or underwent reamputation within nine months post-LLA were undernourished shortly after amputation.
Interviews revealed that nutritional choices were mainly guided by taste and habits, with limited awareness or knowledge of adequate intake and its impact on recovery. Healthcare professionals reported that nutritional care is not routinely embedded in CLTI care, due to barriers such as lack of knowledge, unawareness of existing screening tools, patient-related factors, and time constraints.
After LLA, physical activity increased over time but remained low. Higher physical activity level was associated with longer survival, higher physical and psychological quality of life, and less impaired wound healing.
Together, these findings highlight the need for personalized, multimodal interventions targeting nutrition and physical activity before and after dysvascular major LLA, to support recovery, optimize clinical outcomes, and improve quality of life.