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1. Advancing Inflammatory Bowel Disease Treatment by Targeting the Innate Immune System and Precision Drug Delivery.

Author

Kiilerich, Kat F., Andresen, Trine, Darbani, Behrooz, Gregersen, Laura H. K., Liljensøe, Anette, Bennike, Tue B., Holm, René, Moeller, Jesper B., and Andersen, Vibeke

Subjects
DRUG delivery systems, THERAPEUTICS, ULCERATIVE colitis, REACTIVE oxygen species, INFLAMMATORY bowel diseases, DRUG target, CROHN'S disease
Abstract

Inflammatory bowel disease (IBD), encompassing Crohn's disease and ulcerative colitis, involves chronic inflammation of the gastrointestinal tract. Current immune-modulating therapies are insufficient for 30–50% of patients or cause significant side effects, emphasizing the need for new treatments. Targeting the innate immune system and enhancing drug delivery to inflamed gut regions are promising strategies. Neutrophils play a central role in IBD by releasing reactive oxygen species (ROS) and neutrophil extracellular traps (NETs) —DNA-based structures with cytotoxic proteins—that contribute to mucosal damage and inflammation. Recent studies linking ROS production, DNA repair, and NET formation have identified NETs as potential therapeutic targets, with preclinical models showing positive outcomes from NET inhibition. Innovative oral drug delivery systems designed to target gut inflammation directly—without systemic absorption—could improve treatment precision and reduce side effects. Advanced formulations utilize properties such as particle size, surface modifications, and ROS-triggered release to selectively target the distal ileum and colon. A dual strategy that combines a deeper understanding of IBD pathophysiology to identify inflammation-related therapeutic targets with advanced drug delivery systems may offer significant promise. For instance, pairing NET inhibition with ROS-responsive nanocarriers could enhance treatment efficacy, though further research is needed. This synergistic approach has the potential to greatly improve outcomes for IBD patients. [ABSTRACT FROM AUTHOR]

Published
2025
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2. Food Is Medicine: Diet Assessment Tools in Adult Inflammatory Bowel Disease Research.

Author

Andersen, Vibeke, Liljensøe, Anette, Gregersen, Laura, Darbani, Behrooz, Halldorsson, Thorhallur Ingi, and Heitmann, Berit Lilienthal

Abstract

Background: Diet significantly impacts the onset and progression of inflammatory bowel disease (IBD), and diet offers unique opportunities for treatment and preventative purposes. However, despite growing interest, no diet has been conclusively associated with improved long-term clinical and endoscopic outcomes in IBD, and evidence-based dietary guidelines for IBD remain scarce. This narrative review critically examines dietary assessment methods tailored to the unique needs of IBD, highlighting opportunities for precision and inclusivity. Methods: We conducted a comprehensive literature review using search terms related to diet, diet assessment, nutrition, food, sex, gender, equity, and IBD. Results: The identified dietary assessment tools evaluated nutritional quality, dietary patterns, food processing, lifestyle interactions, inflammatory potential, and effects of specific nutrients. Advanced methods, including biomarkers, multi-omics approaches, and digital tools, were highlighted as being complementary to traditional approaches, offering enhanced precision and real-time monitoring. Women remain under-represented in dietary research but face unique nutritional needs due to hormonal cycles, pregnancy, and higher malnutrition risks in IBD. Discussion: Traditional diet assessment methods remain valuable but are often limited by misreporting biases. Advanced approaches may provide greater precision, enabling real-time monitoring and personalised dietary tracking. Incorporating considerations of sex, gender, age, ethnicity, socioeconomic, and sustainability enhances the relevance and applicability of these methods. Addressing these multifaceted aspects of dietary assessment in IBD can facilitate robust interventional trials. Conclusions: Diet assessment tools are essential for developing personalised dietary interventions in IBD, informing evidence-based guidelines, and improving health outcomes and quality of life in IBD. [ABSTRACT FROM AUTHOR]

Published
2025
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5. Long-term results after weight loss intervention in knee arthroplasty patients with obesity

Author

Anne Thomasen, Inger Mechlenburg, Jens Ole Laursen, and Anette Liljensøe

Subjects
musculoskeletal diseases, Treatment Outcome, Diabetes Mellitus, Type 2, Knee Joint, Weight Loss, Quality of Life, Humans, Obesity, Recovery of Function, Osteoarthritis, Knee, Range of Motion, Articular, Arthroplasty, Replacement, Knee, Follow-Up Studies
Abstract

INTRODUCTION: Obesity is a well-known problem in patients undergoing total knee arthroplasty (TKA). We have previously shown that it is feasible and safe to implement an intensive weight loss programme shortly before TKA. Preoperatively, the programme produced an average weight loss of 10.7 kg while also improving body composition and reducing cardiovascular risk factors. One year after TKA, the patients in the weight loss programme managed to maintain their weight loss, whereas no change was observed in the control group. Both groups showed major improvements in health-related quality of life (QoL) and knee function. The aim of this study was to investigate the long-term effect of a weight loss intervention in patients with obesity undergoing TKA.METHODS: This was a seven-year follow-up study from a randomized controlled trial. Body weight, blood pressure and waist circumference were measured. Additionally, data on patient-reported outcome, range of knee motion (ROM), hypertension and diabetes status were collected.RESULTS: Forty-nine patients were examined at the follow-up. No differences were found between the intervention and the control group on body weight, hypertension, diabetes, waist circumference or knee ROM. The intervention group had increased their mean weight significantly more than the control group (difference = 3.1, 95% confidence interval: 1.3-4.8). 66% had hypertension and 38% had Type 2 diabetes. Pain, function and QoL were improved for both groups.CONCLUSION: The patients in the intervention group were unable to maintain their preoperative weight loss when measured seven year after TKA.FUNDING: none. TRAIL REGISTRATION. not relevant.

Published
2022

7. Weight Loss Intervention Before Total Knee Replacement: A 12-Month Randomized Controlled Trial

Author

Anette Liljensøe, H Bliddal, Inger Mechlenburg, Kjeld Søballe, and J.O. Laursen

Subjects
Male, joint replacement, medicine.medical_treatment, DISEASE, Total knee, law.invention, Absorptiometry, Photon, 0302 clinical medicine, Randomized controlled trial, Quality of life, OBESE-PATIENTS, law, Weight loss, Medicine, Single-Blind Method, Arthroplasty, Replacement, Knee, RISK, Aged, 80 and over, 030222 orthopedics, Middle Aged, Osteoarthritis, Knee, Preoperative Period, Body Composition, Female, medicine.symptom, medicine.medical_specialty, Joint replacement, Total knee replacement, leptin, knee osteoarthritis, 03 medical and health sciences, Intervention (counseling), Weight Loss, SURGICAL SITE INFECTION, Humans, Obesity, ARTHROPLASTY, Aged, 030203 arthritis & rheumatology, OVERWEIGHT, business.industry, OSTEOARTHRITIS SYMPTOMS, Recovery of Function, medicine.disease, PREVENTION, MAINTENANCE, quality of life, Quality of Life, Physical therapy, Surgery, weight loss, business
Abstract

Background and Aims: Obesity is an increasing problem in patients after total knee replacement. The aim of this study was to investigate whether a weight loss intervention before primary total knee replacement would improve quality of life, knee function, mobility, and body composition 1 year after surgery. Material and Methods: Patients scheduled for total knee replacement due to osteoarthritis of the knee and obesity were randomized to a control group receiving standard care or to an intervention group receiving 8-week low-energy diet before total knee replacement. Patient-reported quality of life, 6-Min Walk Test, and body composition by dual-energy X-ray absorptiometry were assessed before intervention for the diet group, and within 1 week preoperatively for both groups, and the changes in outcome from baseline to 1 year after total knee replacement were compared between groups. The number of participants was lower than planned, which might introduce a type-2 error and underestimate the trend for a better outcome after weight loss. Results: The analyses are based on a total of 76 patients, 38 in each group. This study showed major improvement in both study groups in quality of life and knee function, though no statistically significant differences between the groups were observed 1 year after total knee replacement. The average weight loss after 8-week preoperative intervention was 10.7 kg and consisted of a 6.7 kg reduction in fat mass. One year after total knee replacement, the participants in the diet group managed to maintain the weight reduction, whereas there was no change in the control group. Conclusion: The results suggest that it is feasible and safe to implement an intensive weight loss program shortly before total knee replacement. The preoperative intervention resulted in a 10% body weight loss, improved body composition, lower cardiovascular risk factors, and sustained s-leptin.

Published
2019
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9. Is high body mass index a potential risk factor for poor outcome after hip arthroplasty? A cohort study of 98 patients 1 year after surgery

Author

Anette, Liljensøe, Jens Ole, Laursen, Kjeld, Søballe, and Inger, Mechlenburg

Subjects
Male, Postoperative Complications, Treatment Outcome, Risk Factors, Arthroplasty, Replacement, Hip, Quality of Life, Humans, Female, Obesity, Prospective Studies, Osteoarthritis, Hip, Aged, Body Mass Index
Abstract

The association between obesity and outcome after hip arthroplasty is controversial. We investigated whether there was an association between the preoperative body mass index in primary total hip arthroplasty patients and their quality of life and physical function 1 year after surgery. 98 patients were included in the study. The results were adjusted for age, sex, and comorbidities. The obese group had an increased risk of obtaining a worse physical score and a lower activity in daily living score at the 1-year follow-up than compared with the normal-weight group. In addition, the obese patients' hospitalization was 1 day longer than that of the normal-weight patients. However, the overweight patients accomplished the largest improvement of general health and hip-related health compared with the normal-weight group.

Published
2019

10. Is high body mass index a potential risk factor for poor outcome after hip arthroplasty?:A cohort study of 98 patients 1 year after surgery

Author

Liljensøe, Anette, Laursen, Jens Ole, Søballe, Kjeld, and Mechlenburg, Inger

Abstract

The association between obesity and outcome after hip arthroplasty is controversial. We investigated whether there was an association between the preoperative body mass index in primary total hip arthroplasty patients and their quality of life and physical function 1 year after surgery. 98 patients were included in the study. The results were adjusted for age, sex, and comorbidities. The obese group had an increased risk of obtaining a worse physical score and a lower activity in daily living score at the 1-year follow-up than compared with the normal-weight group. In addition, the obese patients' hospitalization was 1 day longer than that of the normal-weight patients. However, the overweight patients accomplished the largest improvement of general health and hip-related health compared with the normal-weight group.

Published
2019

13. Weight Loss Intervention Before Total Knee Replacement: A 12-Month Randomized Controlled Trial

Author

Liljensøe, A., Laursen, J. O., Bliddal, H., Søballe, K., and Mechlenburg, I.

Abstract

Background and Aims: Obesity is an increasing problem in patients after total knee replacement. The aim of this study was to investigate whether a weight loss intervention before primary total knee replacement would improve quality of life, knee function, mobility, and body composition 1 year after surgery.Material and Methods: Patients scheduled for total knee replacement due to osteoarthritis of the knee and obesity were randomized to a control group receiving standard care or to an intervention group receiving 8-week low-energy diet before total knee replacement. Patient-reported quality of life, 6-Min Walk Test, and body composition by dual-energy X-ray absorptiometry were assessed before intervention for the diet group, and within 1 week preoperatively for both groups, and the changes in outcome from baseline to 1 year after total knee replacement were compared between groups. The number of participants was lower than planned, which might introduce a type-2 error and underestimate the trend for a better outcome after weight loss.Results: The analyses are based on a total of 76 patients, 38 in each group. This study showed major improvement in both study groups in quality of life and knee function, though no statistically significant differences between the groups were observed 1 year after total knee replacement. The average weight loss after 8-week preoperative intervention was 10.7 kg and consisted of a 6.7 kg reduction in fat mass. One year after total knee replacement, the participants in the diet group managed to maintain the weight reduction, whereas there was no change in the control group.Conclusion: The results suggest that it is feasible and safe to implement an intensive weight loss program shortly before total knee replacement. The preoperative intervention resulted in a 10% body weight loss, improved body composition, lower cardiovascular risk factors, and sustained s-leptin.

Published
2021
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14. Weight loss intervention before total knee arthroplasty-feasibility and safety

Author

Liljensøe, A., Laursen, J. O., Bliddal, H., Søballe, K., and Mechlenburg, I.

Subjects
European *weight reduction *total knee replacement *safety *rheumatology *rheumatic disease human control group patient surgery body weight diet lean body weight obesity weight loss program knee osteoarthritis peroperative complication systolic blood pressure population fat mass dual energy X ray absorptiometry body composition Knee Injury and Osteoarthritis Outcome Score adverse drug reaction Short Form 36 female Denmark cholesterol
Abstract

Background: Annually 8500 total knee arthroplasty (TKA) are performed in Denmark. About 80% of this population is overweight or obese. The present material is part of a longitudinal randomized study (ClinicalTrial.gov: NCT01469403). Objectives: To investigate whether it is feasible and safe to implement an intensive weight loss program in order to reduce preoperative body weight of obese patients before TKA surgery. The primary aim of the Weight Loss Intervention before Total Knee Arthroplasty (WITKA) study is to investigate whether weight loss interventions before total knee arthroplasty (TKA) will improve QoL and physical function 1 year after surgery. Methods: We conducted a single-blind, randomized study. Eligible patients were scheduled for TKA due to osteoarthritis (OA) of the knee and obesity (BMI >30kg/m2). Participants were randomized to either a control group that followed the standard care or a weight loss group that followed a low-energy diet (810 kcal/day) 8 weeks before surgery. Outcomes were assessed before intervention for the weight loss group, and within 1 week preoperatively for both the weight loss group and the control group. The primary outcome in the WITKA study was the Short-Form 36 (SF-36). Secondary outcomes were Knee injury and Osteoarthritis Outcome Score (KOOS), 6 Minutes' Walk Test, and body composition. Results: Included were 77 patients (weight loss group n=38; control group n=39), 71% were females, the mean age was 65 years (range 46-85), and the average BMI was 31. The average weight loss after 8 weeks was 10.7 kg (10% of body weight). According to dual energy X-ray absorptiometry (DXA), the weight loss consisted of a 6.7 kg reduction in fat mass, a 3.0 kg reduction in lean body mass, and lean body mass increased by 2.3%. In addition, cholesterol decreased and systolic blood pressure decreased by 12 mm/Hg. The intensive diets had few and mild adverse effects. Serious cardiac complications were found in two cases in the intervention group and in one case in the control group. All three patients later underwent TKA without complications. No perioperative complications were recorded in any group. Conclusions: Our results suggest that it is feasible and safe to implement an intensive weight loss program shortly before TKA.

Published
2015
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16. No correlations between radiological angles and self-assessed quality of life in patients with hip dysplasia at 2-13 years of follow-up after periacetabular osteotomy

Author

Sara Birch, Inger Mechlenburg, Charlotte Hartig-Andreasen, Anette Liljensøe, and Kjeld Søballe

Subjects
Adult, Joint Instability, Male, medicine.medical_specialty, Adolescent, Denmark, Statistics as Topic, Logistic regression, Hip dysplasia (canine), Sensitivity and Specificity, Diagnostic Self Evaluation, Young Adult, Quality of life, Risk Factors, Prevalence, Medicine, Hip Dislocation, Humans, Radiology, Nuclear Medicine and imaging, In patient, Longitudinal Studies, Acetabular index, Aged, Pain, Postoperative, Radiological and Ultrasound Technology, Periacetabular osteotomy, business.industry, Physical health, Reproducibility of Results, Acetabulum, General Medicine, Recovery of Function, Middle Aged, respiratory system, humanities, Osteotomy, Radiography, Radiological weapon, Physical therapy, Quality of Life, Female, business
Abstract

Background Only few studies have described patients’ health-related quality of life (QoL) after periacetabular osteotomy (PAO). Thus, there is a lack of data on the self-assessed outcome of patients operated with PAO, and none of the existing studies correlate the results from Medical Outcomes Short Form-36 questionnaire (SF-36) with the radiological parameters. Purpose To investigate the health-related QoL for patients with hip dysplasia operated with PAO and to investigate whether QoL is associated with the acetabular angles or hypermobility. Material and Methods Out of 388 patients, 228 patients (mean age, 40.5 years; mean follow-up, 7.1 years) returned the SF-36 and Beighton questionnaires. The patient’s QoL was compared to reference data from a Danish population. Center-edge (CE) and acetabular index (AI) angles were measured before and after PAO and the association with the patients’ QoL was tested with logistic regression . Results For both men and women the postoperative SF-36 score was significantly lower than for the reference data for a Danish population, especially for those dimensions concerning physical health. No association was found between the patients’ CE or AI angles before or after PAO and their subsequent QoL. Significant associations were found between both Physical Component Score (PCS) and physical function (PF) and follow-up time after the operation. The adjusted OR for a PCS ≥ 50 was 0.87 (95% CI 0.76–0.99) and for a PF ≥ 85 0.81 (95% CI 0.71–0.91). No association between hyper mobility and PCS, PF, or bodily pain (BP) was found. Conclusion The physical components of QoL in patients undergoing PAO are significantly lower than the Danish population used as reference. Furthermore, the results suggest that physical function after PAO decreases with longer follow-up time. Neither the acetabular angles nor hypermobility is associated with the physical components of QoL.

Published
2014
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17. Overweight preoperatively impairs clinical outcome after knee arthroplasty

Author

Liljensøe, Anette, Lauersen, Jens Ole, Søballe, Kjeld, and Mechlenburg, Inger

Subjects
musculoskeletal diseases
Abstract

Background Obesity contributes much to the development of knee osteoarthritis. However, the association between obesity and outcome after knee replacement is controversial. We investigated whether there was an association between the preoperative body mass index (BMI) of patients who underwent total knee arthroplasty (TKA) and their quality of life (QoL) and physical function 3-5 years after surgery. Methods 197 patients who had undergone primary TKA participated in a 3-5 year follow-up study. The outcome measures were the patient-reported Short Form 36 (SF-36) and the American Knee Society score (KSS). Results Ordinal logistic regression analysis (adjusted for age, sex, disease, and surgical approach) revealed a statistically significant correlation between BMI and 9 of the 14 outcome measures. For all outcome measures, we found an odds ratio (OR) of

Published
2013
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24. Patient-reported outcome measures in orthopaedics.

Author

Hansen ST, Jensen RS, Holm HA, and Liljensøe A

Subjects
Humans, Male, Female, Denmark, Middle Aged, Aged, Osteoarthritis, Hip surgery, Osteoarthritis, Hip therapy, Orthopedics, Surveys and Questionnaires, Orthopedic Surgeons, Interviews as Topic, Patient Reported Outcome Measures, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Qualitative Research, Osteoarthritis, Knee surgery, Osteoarthritis, Knee therapy, Patient Participation
Abstract

Introduction: The Patient Activity Treatment Outcome Scale (PATOS) is a novel patient-reported outcome measure (PROM). This study explored patients' and orthopaedic surgeons' experiences with PATOS as part of a PROM battery. It aimed to investigate its influence on patient involvement and healthcare decisions about knee or hip osteoarthritis patients scheduled for knee/hip arthroplasty., Methods: A qualitative research design was adopted using semi-structured interviews with 19 patients and nine orthopaedic surgeons at a Danish orthopaedic surgery department. Thematic analysis was used to develop key themes from interview transcripts., Results: This study adds nuanced insights related to the use of PROMs in routine orthopaedic clinical practice. Home-based completion of PROMs prompted patients to reflect on their situations, priorities and goals regarding potential hip or knee arthroplasty, leading to better-prepared discussions with surgeons. The integration of PATOS with other PROMs made it challenging to discuss PATOS exclusively. Therefore, the results relate to the full PROM battery. The experiences of patients and surgeons were organised into four themes: 1) Patient involvement is key, 2) Questionnaire load, 3) Meaningful home-based completion and 4) PROMs were not used in the decision-making process., Conclusions: The questionnaire load and limited integration into healthcare decision processes raised concerns about the application of the PROM battery. The results emphasise the importance of refining the application of PROMs in orthopaedic practice from the perspectives of patients and surgeons alike., Funding: This work was supported by Innovation Fund Denmark [0172-01258B] TRIAL REGISTRATION. Not relevant., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Published
2024
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25. Long-term results after weight loss intervention in knee arthroplasty patients with obesity.

Author

Thomasen A, Mechlenburg I, Laursen JO, and Liljensøe A

Subjects
Follow-Up Studies, Humans, Knee Joint surgery, Obesity complications, Obesity therapy, Quality of Life, Range of Motion, Articular, Recovery of Function, Treatment Outcome, Weight Loss, Arthroplasty, Replacement, Knee, Diabetes Mellitus, Type 2, Osteoarthritis, Knee surgery
Abstract

Introduction: Obesity is a well-known problem in patients undergoing total knee arthroplasty (TKA). We have previously shown that it is feasible and safe to implement an intensive weight loss programme shortly before TKA. Preoperatively, the programme produced an average weight loss of 10.7 kg while also improving body composition and reducing cardiovascular risk factors. One year after TKA, the patients in the weight loss programme managed to maintain their weight loss, whereas no change was observed in the control group. Both groups showed major improvements in health-related quality of life (QoL) and knee function. The aim of this study was to investigate the long-term effect of a weight loss intervention in patients with obesity undergoing TKA., Methods: This was a seven-year follow-up study from a randomized controlled trial. Body weight, blood pressure and waist circumference were measured. Additionally, data on patient-reported outcome, range of knee motion (ROM), hypertension and diabetes status were collected., Results: Forty-nine patients were examined at the follow-up. No differences were found between the intervention and the control group on body weight, hypertension, diabetes, waist circumference or knee ROM. The intervention group had increased their mean weight significantly more than the control group (difference = 3.1, 95% confidence interval: 1.3-4.8). 66% had hypertension and 38% had Type 2 diabetes. Pain, function and QoL were improved for both groups., Conclusion: The patients in the intervention group were unable to maintain their preoperative weight loss when measured seven year after TKA., Funding: none. TRAIL REGISTRATION. not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Published
2022

26. Is high body mass index a potential risk factor for poor outcome after hip arthroplasty? A cohort study of 98 patients 1 year after surgery.

Author

Liljensøe A, Laursen JO, Søballe K, and Mechlenburg I

Subjects
Aged, Female, Humans, Male, Osteoarthritis, Hip complications, Prospective Studies, Quality of Life, Risk Factors, Treatment Outcome, Arthroplasty, Replacement, Hip adverse effects, Body Mass Index, Obesity complications, Osteoarthritis, Hip surgery, Postoperative Complications etiology
Abstract

The association between obesity and outcome after hip arthroplasty is controversial. We investigated whether there was an association between the preoperative body mass index in primary total hip arthroplasty patients and their quality of life and physical function 1 year after surgery. 98 patients were included in the study. The results were adjusted for age, sex, and comorbidities. The obese group had an increased risk of obtaining a worse physical score and a lower activity in daily living score at the 1-year follow-up than compared with the normal-weight group. In addition, the obese patients' hospitalization was 1 day longer than that of the normal-weight patients. However, the overweight patients accomplished the largest improvement of general health and hip-related health compared with the normal-weight group.

Published
2019

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