Seidell, J.C. [Promotor]Schueren, M.A.E. de van der [Copromotor]Thijs, A. [Copromotor

Neelemaat, F.

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Summary 
Post-discharge nutritional support in malnourished ill elderly patients – 
Effectiveness and cost-effectiveness 
 
 
Introduction 
This thesis describes the effectiveness and cost-effectiveness of post-discharge 
nutritional support in 210 malnourished elderly patients. Patients were randomized into 
an intervention group or a control group. Patients in the intervention group received an 
energy and protein enriched diet, oral nutritional supplements, calcium-vitamin D 
supplementation and were supported by dietetic counselling. Patients in the control 
group received usual care. 
Patients were included on hospital admission and follow-up continued untill three 
months following hospital discharge. Primary outcome parameters were functional 
limitations and physical activities. 
This summary presents the main findings from this study. 
 
 
Summary of main findings 
Effectiveness 
Firstly, a three month duration multi-component nutritional intervention (energy and 
protein enriched diet, oral nutritional support, calcium-vitamin D supplementation 
supported by dietetic counselling) in malnourished patients resulted in an increase in 
body weight. This finding was statistically significant for patients in the highest body 
weight category, but not significant in those with lower body weights.  
Secondly, a statistically significant decrease was found in functional limitations in the 
intervention group compared to the control group. Patients having received the 
nutritional intervention, for example, were able to climb up a stairs and/or dress and 
undress themselves, while patients in the control group could not. What is important 
about this finding is that most patients are less concerned about an increase in their 
body weight while a decrease in functional limitations can play an important role in their 
independence. No statistical significant differences between groups could be 
demonstrated for physical performance, physical activities, fat-free mass, and handgrip 
strength. 
Thirdly, a statistical significant increase was found among patients in the intervention 
group on energy intake, protein intake and serum 25-hydroxy vitamin D compared to 
patients in the control group. A study on fall incidence demonstrated that the number of 
Summary 
 
 
   
159 
 
patients who had experienced falls and the mean number of fall incidents considerably 
decreased in patients in the intervention group, compared to patients in the control 
group. 
Finally, in an exploratory study on the effect of the nutritional intervention on a selection 
of immune parameters, no statistical significant differences between groups in immune 
markers, endocrine markers and a selection of micronutrients could be demonstrated. 
The better health status of the selected group of patients could have played a part in the 
results found. 
 
Cost-effectiveness 
Alongside a significant decrease in functional limitations we were able to demonstrate 
that the given nutritional intervention was cost neutral. Both groups spent 
approximately € 9000 on health related costs in the three months following discharge 
from the hospital. This study concludes that an investment of € 6500 was needed to 
create a 95 percent change to decrease functional limitations. 
This study could not demonstrate cost-effectiveness for quality of life and physical 
activities. 
 
Survival of malnourished cognitively impaired patients 
In a sub-analysis survival was studied in malnourished elderly patients with cognitive 
impairment. Survival minimized among patients diagnosed with a malignancy or 
vascular disease in addition to their malnutrition and cognitive impairment. 
 
Resting energy expenditure; predictive equations versus measurements 
This final study describes the resting energy expenditure of malnourished elderly 
patients. Resting energy expenditure can be measured by indirect calorimetry. However, 
this method is hardly feasible in most clinical settings, due to time consuming 
measurements, lack of trained personnel and expensive equipment. In clinical practice, 
predictive equations to determine resting energy expenditure are used as an alternative 
to solve this problem. In this study 33 different equations were compared to the 
measured values. Predictions of resting energy expenditure for malnourished ill elderly 
patients during hospitalization were subject to significant errors. The best developed 
prediction equations, thus far, predicted only 40% of patients accurately. Three months 
following discharge was this increased to 66%. 
 
 
 
 
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Conclusion 
In conclusion, the studies in this thesis demonstrated that three months nutritional 
intervention in malnourished elderly patients increases body weight, decreases 
functional limitations and decreases falls. No effectiveness could be demonstrated for 
hand grip strength, fat free mass, physical activities and physical performance.  
Future studies could focus on standard post-discharge nutritional support accompanied 
by dietetic counselling. Newly developed specialized elderly welfare centres could play 
an important role in managing this kind of intervention. Promising possibilities are 
nutritional interventions combined with physical activity, especially when provided for a 
minimum period of six months. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Post-discharge nutritional support in malnourished ill elderly patients: Effectiveness and cost-effectiveness

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VU Research PortalPost-discharge nutritional support in malnourished ill elderly patientsNeelemaat, F.2012document versionPublisher's PDF, also known as Version of recordLink to publication in VU Research Portalcitation for published version (APA)Neelemaat, F. (2012). Post-discharge nutritional support in malnourished ill elderly patients: Effectiveness andcost-effectiveness.General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.            • Users may download and print one copy of any publication from the public portal for the purpose of private study or research.            • You may not further distribute the material or use it for any profit-making activity or commercial gain            • You may freely distribute the URL identifying the publication in the public portal ?Take down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.E-mail address:vuresearchportal.ub@vu.nlDownload date: 13. Sep. 2021

Post-discharge nutritional support in malnourished ill elderly patients: Effectiveness and cost-effectiveness

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