ISPOR Nutrition Economics Special Interest Group
Medical Nutrition – Terms, Definitions, Regulations & Emerging Good Practices for Economic Evaluation Working Group



  • Freijer K, Lenoir-Wijnkoop I, Russell CA, Koopmanschap MA, Kruizenga HM, Lhachimi SK, Norman K, Nuijten MJC, Schols JMGA. The view of European experts regarding health economics for medical nutrition in disease-related malnutrition. European Journal of Clinical Nutrition (2015); 69: 539-545. doi:10.1038/ejcn.2014.280.
  • Szabolcs P, EggersdorferM, van Asselt D, Buskens E, Detze P, Freijer K, Koletzko B, Kraemer K, Kuipers F, Neufeld L, Obeid R, Wieser S, Zittermann A, Weber P. Selected nutrients and their implications for health and disease across the lifespan. Nutrients 2014; 6(12): 6076-6094; doi:10.3390/nu6126076.
  • Freijer K. Nutrition Economics; disease related malnutrition and the economic health care value of medical nutrition. PhD thesis 2014.
  • Lenoir-Wijnkoop, M. J. C. Nuijten, I. Gutiérrez-Ibarluzea, et al. Workshop Report: concepts and methods in the economics of nutrition- gateways to better economic evaluation of nutrition interventions. British Journal of Nutrition 2012; 108:1714-1720.
  • Lenoir-Wijnkoop, M. Dapoigny, D. Dubois, E. van Ganse, I. Gutierrez-Ibarluzea, J. Hutton, P. Jones, T. Mittendorf, M. J. Poley, S. Salminen, M. J. C. Nuijten. Nutrition economics - characterizing the economic and health impact of nutrition. British Journal of Nutrition 2011; 105:157-166.


  • I. Lenoir-Wijnkoop, P. J. Jones, R. Uauy, L. Segal, J. Milner. Nutrition economics - food as an ally of public health. British Journal of Nutrition 2013;109 :777-84.
  • Y. Lotan, I. Buendia Jiménez, I. Lenoir-Wijnkoop, M. Daudon, L. Molinier, I. Tack, M. J. C. Nuijten. Increased Water Intake as a Prevention Strategy for Recurrent Urolithiasis: Major Impact of Compliance on Cost-Effectiveness. The Journal of Urology 2013; 189: 935-939
  • F. J. B. Lötters, I. Lenoir-Wijnkoop, P. Fardellone, et al. Dairy foods and osteoporosis: an example of assessing the health-economic impact of food products. Osteoporosis International 2013; 24:139-150
  • Lenoir-Wijnkoop, W. M. C. van Aalderen, G. Boehm, et al. Cost-effectiveness model for a specific mixture of prebiotics in The Netherlands. Eur J Health Economics 2012; 13:101-10
  • C.L. Gyles, I. Lenoir-Wijnkoop, J.G. Carlberg, et al. Health economics and nutrition: a review of published evidence. Nutrition Reviews 2012; 70:693-708
  • Y. Lotan , I. Buendia Jiménez, I. Lenoir-Wijnkoop, M. Daudon , L. Molinier, I. Tack, M. J.C. Nuijten . Primary prevention of nephrolithiasis is cost-effective for a national healthcare system. BJU International 2012; 110: E1060-7.
  • A. Koponen, M. Sandell, S. Salminen, I. Lenoir-Wijnkoop. Nutrition economics: towards comprehensive understanding of the benefits of nutrition. Microbial Ecology in Health and Disease. 2012; 23. doi: 10.3402/mehd.v23i0.18585.
  • M. Nuijten, I. Lenoir-Wijnkoop. Nutrition economics: An innovative approach to informed public health management. European Journal of Pharmacology 2011; 668: S133-S137


  • Freijer K, Tan SS, Koopmanschap MA, Meijers JMM, Halfens RJG, Nuijten MJC. The economic costs of disease related malnutrition. Clin Nutr 2013; 32: 136-141
  • Rice N., Norman C. The cost associated with disease related malnutrition in Ireland. Public Health Nutr 2012 Oct; 15(10):1966-72.
  • Meijers JM, Halfens RJ, Wilson L, Schols JM. Estimating the costs associated with malnutrition in Dutch nursing homes. Clin Nutr 2012; 31(1):65-68.
  • Lim SL, Ong KC, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr 2011;31(3):345-350.
  • Álvarez-Hernández J, Planas Vila M, León-Sanz M, García de Lorenzo A, Celaya-Pérez S, García-Lorda P, Araujo K, Sarto Guerri B; PREDyCES researchers. Prevalence and costs of malnutrition in hospitalized patients; the PREDyCES Study. Nutr Hosp 2012; 27(4): 1049-1059. Updated data of Spanish costs related to malnutrition from the PREDyCES Study are available at
  • Baumeister SE, Fischer B, Doring A, Koenig W, Zierer A, John J et al. The Geriatric Nutritional Risk Index predicts increased healthcare costs and hospitalization in a cohort of community-dwelling older adults: results from the MONICA/KORA Augsburg cohort study, 1994-2005. Nutrition 2011; 27(5):534-542.
  • Guest JF; Panca M; Baeyens JP; de Man F; Ljungqvist O; Pichard C; Wait S; Wilson L. Health. Economic impact of managing patients following a community-based diagnosis of malnutrition in the UK. Clinical Nutrition. 2011. Clin Nutr. 2011 30:422-9.
  • Rowell DS, Jackson TJ. Additional costs of inpatient malnutrition, Victoria, Australia, 2003- 2004. Eur J Health Econ 2011; 12(4):353-361.
  • Collins PF, Stratton RJ, Elia M. An economic analysis of the costs associated with weight status in chronic obstructive pulmonary disease (COPD). Proc Nutr Soc 2011; 70(OCE5): E324.(Abstract)
  • E. Preaud, J.C. Melchior, J. Carles, M. Brami, G. Duru, E. Fontaine, X. Hábuterne, B. Lukacs, J.F. Zazzo, Y. Panis, G. Nitenberg. Medico-Economic Analysis of the Impact of Malnutrition on the Post-Operative Course of Colorectal Cancer Patients. Value in Health 2011; 14: A262 (Abstract)
  • Cawood AL, Rust S, Walters E, Stratton RJ, Elia M. The impact of malnutrition on health care use in hopsital outpatients. Proc Nutr Soc 2010; 69:E149.(Abstract)
  • Cawood AL, Green C, Stratton RJ. The budget impact of using oral nutritional supplements in older community patients at high risk of malnutrition in England. Proc Nutr Soc 2010; 69:E544.(Abstract)
  • Ljungqvist O, van Gossum A, Sanz M, de Man F. The European fight against malnutrition. Clin Nutr 2010; 29(2):149-150.
  • Banks MD, Graves N, Bauer JD, Ash S. The costs arising from pressure ulcers attributable to malnutrition. Clin Nutr 2010; 29(2):180-186.
  • Ljungqvist O, de Man F. Under nutrition - a major health problem in Europe. Nutr Hosp 2009; 24(3):368-370.
  • Elia M, Stratton RJ. Calculating the cost of disease-related malnutrition in the UK in 2007 (public expenditure only) In Combating Malnutrition: Recommendations for action. Report from the Advisory Group on Malnutrition, Led by BAPEN. Redditch, BAPEN. 2009.(Report)
  • Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008; 27(1):5-15.
  • Russell C. The impact of malnutrition on healthcare costs and economic considerations for the use of oral nutritional supplements. Clin Nutr 2007; 2(Suppl 1):25-32.
  • Cepton. Malnutrition in Germany: A study on disease-related malnutrition and the benefits of clinical nutrition concepts. Munich. 2007. (Report)
  • Elia M, Stratton RJ, Russell C, Green CJ, Pang F. The cost of disease-related malnutrition in the UK and economic considerations for the use of oral nutritional supplements (ONS) in adults. Redditch, BAPEN. 2005.(Report)
  • Ethgen O, Spaegen E, Moeremans K, Annemans L. Economic impact of hospital malnutrition. Value in Health 2005; 8(6):A68-A69. (Abstract)
  • United States National Statistics for Principal Diagnosis, Hospital Stay, Cost and Mortality as Related to the Burden of Dysphagia; HSTAT. NLM AHRQ 2002.Evidence reports and summaries, Appendix B. Burden of illness of dysphagia and its complications in neurologic disease.


Management of disease related malnutrition in adults

  • Freijer K, Bours MJL, Nuijten MJC, Poley MJ, Meijers JMM, Halfens RJG, Schols JMGA.The economic value of enteral medical nutrition in the management of Disease Related Malnutrition: a systematic review. JAMDA 2014;15:17-29.
  • Walzer S, Droeschel D, Nuijten M et al. Health economics evidence for medical nutrition: are these interventions value for money in integrated care? ClinicoEconomics and Outcomes Research 2014; 6: 241-252.
  • Mauskopf JA, Candrilli SD, Chevrou-Séverac, et al. Immunonutrition for patients undergoing elective surgery for gastrointestinal cancer: impact on hospital costs. World J Surg Oncol 2012, 10:136.
  • Milte RK, Ratcliffe J, Miller MD, Crotty M. Economic evaluation for protein and energy supplementation in adults: opportunities to strengthen the evidence. Eur J Clin Nutr 2013; 67(12):1243-50
  • V. Manásek, K. Bezdek A. Foltys, K. Klos, J. Smitka, D. Nmehlík. Effect of peri-operative high protein nutritional support on post-operative complications and costs of treatment in patients with colorectal cancer. European Cancer Congress - Congress Proceedings 2013: A 2270 (Abstract)
  • Wyers CE, Reijven PLM, Evers SMAA, et al. Cost-effectiveness of nutritional intervention in elderly subjects after hip fracture. A randomized controlled trial. Osteoporos Int 2013; 24: 151-162.
  • Philipson TJ, Thornton Snider J, Lakdawalla DN, et al. Impact of oral nutritional supplementation on hospital outcomes. Am J Manag Care 2013; 19: 121-128.
  • Medical Nutrition International Industry (MNI). Oral Nutritional Supplements to Tackle Malnutrition- a summary of the evidence base 2012. (Report; can be downloaded from
  • Freijer K, Nuijten MJC, Schols JMGA. 2012. The budget impact of oral nutritional supplements for disease related malnutrition in elderly in the community setting. Front Pharmacol 2012; 78: 1-8 (doi: 10.3389/fphar.2012.00078).
  • Neelemaat F, Bosmans JE, Thijs A, et al. Oral nutritional support in malnourished elderly decreases functional limitations with no extra costs. Clin Nutr 2012; 31: 183-190.
  • Nuijten M, Mittendorf T. The health economic impact of oral nutritional supplements (ONS) in Germany. Aktuel Ernahrungsmed 2012: 37: 126-133.
  • Norman K, Pirlich M, Smoliner C, et al. Cost-effectiveness of a 3-month intervention with oral nutritional supplements in disease-related malnutrition: a randomised controlled pilot study. Eur J Clin Nutr 2011; 65: 735-42.
  • Freijer K, Nuijten MJC. Analysis of the health economic impact of medical nutrition in the Netherlands. Eur J Clin Nutr 2010; 64: 1229-1234.
  • Van Wetering CR, Hoogendoorn M, Broekhuizen R, et al. Efficacy and Costs of Nutritional Rehabilitation in Muscle-Wasted Patients with chronic obstructive pulmonary disease in acommunity-based setting: a prespecified subgroup analysis of the INTERCOM trial. J Am Med Dir Assoc 2010; 11: 179-187
  • Cawood AL, Green C, Stratton RJ. The budget impact of using oral nutritional supplements in older community patients at high risk of malnutrition in England. Proc Nutr Soc 2010; 69:E544.(Abstract)
  • Cawood AL, Elia M, Stratton RJ. Meta-analysis shows reduced health care use and costs with oral nutritional supplements. Clin Nutr 2010; 5(Suppl 1):123. (Abstract)
  • Elia M, Stratton R. A cost-utility analysis in patients recieving enteral tube feeding at home and in nursing homes. Clin Nutr 2008; 27: 416-23.
  • Stratton RJ, Ek AC, Engfer M, Moore Z, Rigby P, Wolfe R et al. Enteral nutritional support in prevention and treatment of pressure ulcers: a systematic review and meta-analysis. Ageing Res Rev 2005; 4(3):422-450.
  • Louie BE, Noseworthy T, Hailey D, et al. Enteral or parenteral nutrition for severe pancreatitis: A randomized controlled trial and health technology assessment. Can J Surg 2005; 48: 298-306.
  • Zhang K, Sun W B, Wang HF, et al. Early enteral and parenteral nutritional support in patients with cirrhotic portal hypertension after pericardial revascularization. Hepatobiliary Pancreat Dis Int 2005; 4: 55-59.
  • Arnaud-Battandier F, Malvy D, Jeandel C, et al. Use of oral supplements in malnourished elderly patients living in the community: a pharmaco-economic study. Clin Nutr 2004; 23: 1096-103.
  • Smedley F, Bowling T, James M, et al. Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care. Br J Surg 2004; 91: 983-990.
  • Rypkema G, Adang E, Dicke H, et al. Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition. J Nutr Health Aging 2003; 8: 22-27.
  • Jones C, Palmer ATE, Griffiths RD. Randomized clinical outcome study of critically ill patients given glutamine-supplemented enteral nutrition. Nutrition 1999; 15: 108-115
  • American Dietetic Association. Cost-effectiveness of medical nutrition therapy. J Am Diet Assoc 1995; 95: 88-91.

Management of Critical Illness

  • Doig GS, Chevrou-Séverac H, Simpson F. Early enteral nutrition in critical illness: a full economic analysis using US costs. Clinico Economics and Outcomes Research 2013; 5 : 429 - 436
  • Cangelosi MJ, Auerbach HR, Cohen JT.A clinical and economic evaluation of enteral nutrition. Curr Med Res Opin. 2011 Feb;27(2):413-22.
  • Management of cow's milk allergy
  • Verdegem P.J.,Samuel P. Health care resource use and time to diagnosis attributable to managing cow milk allergy in the USA: current estimates and predicted effects of legislation that requires health care coverage for amino acid formulas. Value in Health 2010; 13; 3:A201 (Abstract)
  • Sladkevicius E., Guest J.F. Budget impact of managing cow milk allergy in the Netherlands. Journal of Medical Economics 2010; 13: 273-283
  • Guest J.F., Nagy E. Modelling the resource implications and budget impact of managing cow milk allergy in Australia Current Medical Research and Opinions 2010; 25: 339-349
  • Guest J.F., Valovirta E. Modelling the resource implications and budget impact of new reimbursement guidelines for the management of cow milk allergy in Finland Current Medical Research and Opinions 2008; 24: 1167-1177

Management/Prevention Of Pressure Ulcers

  • E. Cereda, C. Klersy, A. Crespi, F. D'Andrea - on behalf of OEST Study Group. Disease-specific nutritional support in malnourished pressure ulcer patients: a double-blind, randomized-controlled trial. Clinical Nutrition (special Congress supplement) 2013: 1135
  • Elia M, Stratton RJ. A cost-benefit analysis of oral nutritional supplements in preventing pressure ulcers in hospital. Clin Nutr 2005; 24:640-641.

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Medical Nutrition – Terms, Definitions, Regulations WG