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Open Access Research

Study protocol: Cost-effectiveness of transmural nutritional support in malnourished elderly patients in comparison with usual care

Floor Neelemaat1*, Abel Thijs2, Jaap C Seidell3, Judith E Bosmans4 and Marian AE van Bokhorst-de van der Schueren1

Author Affiliations

1 Departments of Nutrition and Dietetics, Internal Medicine and EMGO+ institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands

2 Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands

3 Department of Nutrition and Health, Institute for Health Sciences, VU University, Amsterdam, The Netherlands

4 Section of Health Economics & Health Technology Assessment, Department of Health Sciences and EMGO+ Institute for Health and Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands

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Nutrition Journal 2010, 9:6  doi:10.1186/1475-2891-9-6

Published: 10 February 2010

Abstract

Background

Malnutrition is a common consequence of disease in older patients. Both in hospital setting and in community setting oral nutritional support has proven to be effective. However, cost-effectiveness studies are scarce. Therefore, the aim of our study is to investigate the effectiveness and cost-effectiveness of transmural nutritional support in malnourished elderly patients, starting at hospital admission until three months after discharge.

Methods

This study is a randomized controlled trial. Patients are included at hospital admission and followed until three months after discharge. Patients are eligible to be included when they are ≥ 60 years old and malnourished according to the following objective standards: Body Mass Index (BMI in kg/m2) < 20 and/or ≥ 5% unintentional weight loss in the previous month and/or ≥ 10% unintentional weight loss in the previous six months. We will compare usual nutritional care with transmural nutritional support (energy and protein enriched diet, two additional servings of an oral nutritional supplement, vitamin D and calcium supplementation, and consultations by a dietitian). Each study arm will consist of 100 patients. The primary outcome parameters will be changes in activities of daily living (determined as functional limitations and physical activity) between intervention and control group. Secondary outcomes will be changes in body weight, body composition, quality of life, and muscle strength. An economic evaluation from a societal perspective will be conducted alongside the randomised trial to evaluate the cost-effectiveness of the intervention in comparison with usual care.

Conclusion

In this randomized controlled trial we will evaluate the effect of transmural nutritional support in malnourished elderly patients after hospital discharge, compared to usual care. Primary endpoints of the study are changes in activities of daily living, body weight, body composition, quality of life, and muscle strength. An economic evaluation will be performed to evaluate the cost-effectiveness of the intervention in comparison with usual care.

Trial registration

Netherlands Trial Register (ISRCTN29617677, registered 14-Sep-2005)