Effect of a Nutrition Supplement and Physical Activity Program on Pneumonia and Walking Capacity in Chilean Older People: A Factorial Cluster Randomized Trial

Dangour, Alan D.; Albala, Cecilia; Allen, Elizabeth; Grundy, Emily; Walker, Damian; Aedo, Cristián; Sánchez, Hugo; Fletcher, Olivia; Elbourne, Diana; Uauy, Ricardo

doi:10.1371/journal.pmed.1001023

Cited by 40 publications

(51 citation statements)

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“…[29][30][31][32][33][34][35][36][37][38] Although relatively more studies were identified in this category, the studies were very diverse in terms of setting, interventions, and outcomes measured, making any direct comparisons across studies very difficult. In terms of study design, a range of designs were employed including randomised designs, [29][30][31]35 a number of non or quasi-randomised designs 32,33,36,37 and modelled studies. 34,38 Although sample size varied from less than 100 to over 2000, half of the studies included between 100 and 300 participants.…”

Section: Results Of Studies Where Participants Were Defined As Malnoumentioning

confidence: 99%

“…Of the identified studies only one utilized a cost-utility approach. 29 This study assessed a multidisciplinary intervention including exercise and smoking cessation counselling in addition to ONS in community dwelling adults with chronic obstructive pulmonary disease and was found to be near the cost effectiveness threshold at AUD$39,438 per QALY gained ( patients with COPD discharged to the community, 29 community dwelling older adults, 30 and a large number focusing on patients from various hospital wards. [32][33][34][35][36]38 Follow up period was similarly varied across the studies ranging from the duration of hospital stay to a two year period, with the greatest proportion of studies (five out of nine) centred on the period of hospitalisation.…”

Section: Results Of Studies Where Participants Were Defined As Malnoumentioning

confidence: 99%

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Economic evaluation for protein and energy supplementation in adults: opportunities to strengthen the evidence

et al. 2013

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Malnutrition is a costly problem for health care systems internationally. Malnourished individuals require longer hospital stays and more intensive nursing care than adequately nourished individuals and have been estimated to cost an additional £7.3 billion in health care expenditures in the United Kingdom alone. However, treatments for malnutrition have rarely been considered from an economic perspective. The aim of this systematic review was to identify the cost effectiveness of using protein and energy supplementation, as a widely used intervention to treat adults with and at risk of malnutrition. Papers were identified that included economic evaluations of protein or energy supplementation for the treatment or prevention of malnutrition in adults. While the variety of outcome measures reported for cost effectiveness studies made synthesis of results challenging, cost benefit studies indicated that the savings for the health system could be substantial due to reduced lengths of hospital stay and less intensive use of health services after discharge. In summary the available economic evidence indicates that protein and energy supplementation in treatment or prevention of malnutrition provides an opportunity to improve patient wellbeing and lower health system costs.

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Section: Results Of Studies Where Participants Were Defined As Malnoumentioning

confidence: 99%

Section: Results Of Studies Where Participants Were Defined As Malnoumentioning

confidence: 99%

Economic evaluation for protein and energy supplementation in adults: opportunities to strengthen the evidence

et al. 2013

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“…Variables-Adherence was defined a priori as registered attendance at a minimum of 24 PA classes spread over at least 12 months [17].…”

Section: Quantitative Methodsmentioning

confidence: 99%

Adherence to a physical activity intervention among older adults in a post-transitional middle income country: A quantitative and qualitative analysis

Garmendia

Dangour

Albala

et al. 2012

J Nutr Health Aging

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Objectives-The effectiveness of community level interventions depends to a great extent on adherence. Currently, information on factors related to adherence in older adults from developing countries is scarce. Our aim was to identify factors associated to adherence to a physical activity intervention in older adults from a post-transitional middle income country.Design, setting and participants-Using a combination of quantitative and qualitative methods we studied 996 older Chilean subjects (65-67.9 years at baseline) with low to medium socioeconomic status from 10 health centers randomized to receive a physical activity intervention as part of the CENEX cluster trial (ISRCTN48153354).Measurements-Using a multilevel regression model, the relationship between adherence (defined a priori as attendance at a minimum of 24 physical activity classes spread over at least 12 months) and individual, intervention-related and contextual factors was evaluated. We also conducted 40 semi-structured interviews with older adults (n=36) and instructors (n=4). Transcripts of the interviews were analyzed using content analysis to identify barriers and facilitators to adherence.Results-Adherence to physical activity intervention was 42.6% (CI 95% 39.5 to 45.6). Depression, diabetes mellitus, percentage of impoverished households and rate of arrests for violent crimes in the neighborhood predicted less adherence (p<0.05) while being retired, participation in physical activity prior to the intervention, and green areas per habitant were positively associated with adherence (p<0.05). The qualitative interviews identified three primary § Corresponding author: Maria Luisa Garmendia, Institute of Nutrition and Food Technology, Universidad de Chile. El Líbano 5524, Macul, Santiago, Chile. Phone: 5629781402, Fax: 5622214030, mgarmend@inta.uchile.com. Competing InterestsAll authors declare that they have no competing interests. Author´s ContributionsA.D. Dangour and R. Uauy conceived and designed the CENEX study. D. Dangour C. Albala and R. Uauy applied for the funding. C. Albala, R. Uauy and M.L. Garmendia conceived the present manuscript. M.L. Garmendia wrote the first draft paper. P. Eguiguren provided qualitative studies expertise. E. Allen collaborated in data analysis. All authors read and approved the final version of the manuscript. Europe PMC Funders GroupAuthor Manuscript J Nutr Health Aging. Author manuscript; available in PMC 2017 April 11. Europe PMC Funders Author ManuscriptsEurope PMC Funders Author Manuscripts barriers to adherence: current health problems, lack of time due to commitments for caring for family members, and being employed, and two primary facilitators to adherence: the health benefits attributed to the intervention and the opportunity the classes provided for social interaction with others.Conclusion-In order to enhance effectiveness of community exercise interventions, strategies to improve participation should be targeted to older adults from deprived areas and those with psychological and medical ...

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“…These are costeffectiveness analysis (CEA) and cost-utility analysis (CUA) ( Table 2). CEA was undertaken in six studies, [13,17,19,23,26,27] whereas CUA was undertaken in nine studies, [14][15][16][20][21][22]24,25,28] with one study undertaking both cost-consequence and cost-utility analysis [18]. All studies gave a justification of why they employed each economic evaluation technique and it was found to be appropriate to the research objectives.…”

Section: Summary Of Selected Studiesmentioning

confidence: 99%

“…Six studies had their primary outcome of interest reported in cost per unit effect [13,17,19,23,26,27] whereas ten studies reported their primary outcomes in cost per Quality Adjusted Life Year (QALY)…”

Section: Costs and Outcomesmentioning

confidence: 99%

Economic evaluation alongside factorial trials: a systematic review of empirical studies

Frempong

Goranitis

Oppong³

2015

Expert Review of Pharmacoeconomics & Outcomes Research

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Effect of a Nutrition Supplement and Physical Activity Program on Pneumonia and Walking Capacity in Chilean Older People: A Factorial Cluster Randomized Trial

Abstract: Alan Dangour and colleagues report results from the CENEX (Cost-effectiveness Evaluation of a Nutritional supplement and EXercise program for older people) trial, which evaluates a nutritional and exercise program aiming to prevent pneumonia and physical decline in Chilean people.

Cited by 40 publications

References 40 publications

Economic evaluation for protein and energy supplementation in adults: opportunities to strengthen the evidence

Economic evaluation for protein and energy supplementation in adults: opportunities to strengthen the evidence

Adherence to a physical activity intervention among older adults in a post-transitional middle income country: A quantitative and qualitative analysis

Economic evaluation alongside factorial trials: a systematic review of empirical studies

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