The Unhealthy Lifestyle Factors Associated with an Increased Risk of Poor Nutrition among the Elderly Population in China

Global prevalence of malnutrition in older adults: A comprehensive systematic review and meta-analysis

Objectives

Early detection and management of malnutrition is essential for the general health and well-being of the elderly. Various studies have reported different types of malnutrition prevalence in the elderly. the present study was aimed to determine the prevalence of malnutrition in the world' elderly through conducting a systematic review study and meta-analysis.Study Design: systematic review and meta-analysis.

Methods

In this review study, data was extracted by searching in national and international databases of SID, MagIran, Google scholar, ScienceDirect, Scopus, PubMed and Web of Science (WoS) without time limit until August 25, 2023. For analysis, Begg and Mazumdar test at a significance level of 0.1 and the corresponding Funnel plot were used. Data analysis was performed with Comprehensive Meta-Analysis software (Version 2).

Results

In the review of 98 studies with a total sample size of 79976, the prevalence of malnutrition in the world's elderly was obtained as 18.6 % (95 % confidence interval: 16.4-21.1 %), so that the highest prevalence of malnutrition was in the elderly of Africa with 35.7 %, followed by the America with 20.3 %. According to the subgroup analysis regarding the indicators of malnutrition in the elderly, the highest prevalence of malnutrition in the elderly was obtained as 39.9 % according the NRS-2002 index.

Conclusion

Therefore, in addition to raising awareness among families about malnutrition in the elderly and its negative effects on the quality of life of the elderly, it is necessary to take the necessary measures to provide more care for the elderly and also to pay serious attention to the importance of nutrition during old age.

Developing a comprehensive malnutrition prediction model for the elderly in nursing homes

PURPOSE

Malnutrition among elderly nursing home residents represents a critical public health challenge, particularly in rapidly aging societies such as China. This study aimed to develop and validate a predictive model for malnutrition risk tailored to this vulnerable population.

METHODS

We analyzed clinical data from 1,023 elderly individuals (aged ≥ 65 years) across 26: nursing homes in Wuhan, China (March-October 2023). Participants were randomly divided into model-building (70%, n = 716) and internal validation cohorts (30%, n = 307). LASSO regression and logistic regression identified key predictors, and a nomogram was constructed. Model performance was assessed via AUC, calibration curves, and decision curve analysis (DCA).

RESULTS

The malnutrition incidence was 46.37%. Five predictors were significant: feeding method (OR = 2.89, 95% CI: 1.75-4.76), dental status (OR = 0.56, 95% CI: 0.37-0.86), physical inactivity (OR = 1.75, 95% CI: 1.09-2.80), Barthel Index (OR = 0.96 per 10-point decrease), and anemia (OR = 1.91, 95% CI: 1.10-3.30). The model showed excellent discrimination (AUC = 0.90, 95% CI: 0.85-0.94) and calibration (mean absolute error = 0.026). DCA indicated clinical utility across threshold probabilities (2-97%).

CONCLUSION

This nomogram provides a robust tool for malnutrition risk stratification in nursing homes. Future studies should validate its generalizability across diverse populations and regions.

Impact of socioeconomic determinants on outcomes of eight select conditions for which self-care is a modality for prevention and treatment: a scoping review

We conducted a scoping review of peer-reviewed literature published between January 1, 1990 and October 31, 2021, to identify socioeconomic determinants that contribute to higher burden and adverse outcomes in diseases for which self-care is an important modality of treatment and prevention. We identified these diseases using over-the-counter medicines sales data sourced from IQVIA. We searched Ovid Medline, PubMed, and EMBASE databases for articles published in English using inclusion/exclusion criteria. We analyzed articles covering 42 diseases that qualified as cardiovascular disorders (219 studies including ischemic heart disease, myocardial infarction, stroke, and related risk factors such as hypertension, dyslipidemia and atrial fibrillation), nutritional disorders (66 studies including malnutrition which encompasses undernutrition and micronutrient deficiencies, and anemia), digestive disorders (40 studies including gastroesophageal reflux disorder, inflammatory bowel disease, and dyspepsia), allergy disorders (40 studies including asthma and allergic rhinitis), pain disorders (14 studies including lower back pain, knee pain, generalized musculoskeletal pain and headaches), dermatological disorders (23 studies including atopic dermatitis [eczema], occupational dermatosis, and facial dermatitis), respiratory disorders (11 studies including chronic cough, pneumonia, chronic bronchitis, wheezing, and influenza), and gynecological disorders (29 studies including bacterial vaginosis and trichomoniasis vaginosis). We found that lifestyle factors were the commonly reported risk factors, and residential segregation, education, and income were the commonly reported socioeconomic determinants. A closer analysis of income within each disorder revealed that it is more often associated with health conditions that are self-limiting. Although we did not find any discernible relationship between the commonly reported socioeconomic factors and the prevalence of self-medication for the health conditions considered, income plays an important role in the burden and outcomes of conditions that require more self-care compared to those that require less self-care.

The Association of Malnutrition and Health-Related Factors among 474,467 Older Community-Dwellers: A Population-Based Data Mining Study in Guangzhou, China

BACKGROUND

This study aimed to examine the prevalence and associated factors of malnutrition in older community-dwellers and explore the interaction between associated factors.

METHODS

A total of 474,467 older community-dwellers aged 65 or above were selected in Guangzhou, China. We used a two-step methodology to detect the associated factors of malnutrition and constructed logistic regression models to explore the influencing factors and interactive effects on three patterns of malnutrition.

RESULTS

The prevalence of malnutrition was 22.28%. Older adults with both hypertension and diabetes (RERI = 0.13), both meat or fish diet and hypertension (RERI = 0.79), and both meat or fish diet and diabetes (RERI = 0.81) had positive additive interaction effects on the risk of obesity, whereas those on a vegetarian diet with hypertension (RERI = -0.25) or diabetes (RERI = -0.19) had negative additive interaction effects. Moreover, the interactions of physical activity with a meat or fish diet (RERI = -0.84) or dyslipidemia (RERI = -0.09) could lower the risk of obesity.

CONCLUSIONS

Malnutrition was influenced by different health factors, and there were interactions between these influencing factors. Pertinent dietary instruction should be given according to different nutritional status indexes and the prevalence of metabolic diseases to avoid the occurrences of malnutrition among older adults.

Chinese expert consensus on prevention and intervention for the elderly with malnutrition (2022)

Malnutrition is a state of altered body composition and body cell mass due to inadequate intake or utilization of energy or nutrients, leading to physical and mental dysfunction and impaired clinical outcomes. As one of the most common geriatric syndromes, malnutrition in the elderly is a significant risk factor for poor clinical outcomes, causing a massive burden on medical resources and society. The risk factors for malnutrition in the elderly are diverse and include demographics, chronic diseases, and psychosocial factors. Presently, recommendations for the prevention and intervention of malnutrition in the elderly are not clear or consistent in China. This consensus is based on the latest global evidence and multiregional clinical experience in China, which aims to standardize the prevention and intervention of malnutrition in the elderly in China and improve the efficacy of clinical practice and the prognosis of elderly patients.

Socioeconomic Risk Factors of Poor Nutritional Status in Polish Elderly Population: The Results of PolSenior2 Study

Poor nutritional status (PNS) threatens successful aging. Identifying potentially modifiable predictors of PNS is essential for elaborating a preventive strategy for the population at risk. To assess the prevalence of PNS in the Polish elderly population and analyze its socioeconomic correlates based on the data from the nationwide PolSenior2 project. Special emphasis was put on potentially modifiable factors among the identified PNS predictors. Nutritional status was assessed in 5698 community-dwelling older adults with the Mini Nutritional Assessment-Short Form. We evaluated the effect of age, sex, level of education, marital status, place of residence, subjective loneliness, and self-reported poverty on the nutritional status of the studied subjects. PNS was found in 25.3% of studied subjects (27.7% women and 21.9% men; p < 0.001). Female sex, older age, unmarried status (in men), subjective loneliness, and self-reported poverty were independent correlates of PNS. The two last above-mentioned predictors were identified as potentially modifiable. Based on our results, we recommend preventive interventions (e.g., performing regular screening), particularly in unmarried (men), poorly educated individuals, self-reporting poverty, complaining of loneliness, and the oldest old. PNS preventive strategies should include social support (both emotional and instrumental) to reduce the effect of poverty and subjective loneliness.

Malnutrition and its associated factors among elderly Chinese with physical functional dependency

OBJECTIVE

To assess the prevalence and to identify the associated factors of malnutrition among elderly Chinese with physical functional dependency.

DESIGN

Face-to-face interviews using standardised questionnaires were conducted to collect demographic information, health-related issues and psychosocial status. Physical function was measured by the Barthel Index (BI), and nutrition status was assessed by the Mini Nutritional Assessment-Short Form. Multivariate binary logistic regression was used to assess associated factors of malnutrition.

SETTING

China.

PARTICIPANTS

A total of 2323 participants (aged ≥ 60 years) with physical functional dependency in five provinces in China were enrolled using a multistage cluster sampling scheme.

RESULTS

The prevalence of malnutrition was 17·9 % (95 % CI 16·3, 19·4). Multivariable binary logistic regression revealed the independent risk factors of poor nutrition status were being female, older age, lower educational status, poor hearing, poor physical functional status, lack of hobbies, low religious participation, poor social support, lack of social participation and changes in social participation. The study found that the most significant independent risk factor for malnutrition was complete physical functional dependence (OR 4·46, 95 % CI 2·92, 6·82).

CONCLUSIONS

The findings of the study confirm that malnutrition and the risk of malnutrition are prevalent in Chinese older adults with physical functional dependency. In addition to demographic and physical health-related factors, psychosocial factors, which are often overlooked, are independently associated with nutrition status in Chinese older adults with physical functional dependency. A holistic approach should be adopted to screen for malnutrition and develop health promotion interventions in this vulnerable population.

Social and Economic Factors and Malnutrition or the Risk of Malnutrition in the Elderly: A Systematic Review and Meta-Analysis of Observational Studies

Malnutrition in the elderly could be tackled by addressing socioeconomic factors. This study aimed to determine the magnitude of the relationship between socioeconomic factors and the malnutrition or malnutrition risk (MR) in the elderly. The PubMed and SCOPUS databases were searched for observational studies that included assessment of malnutrition or/and MR and socioeconomic variables (educational level, living alone, marital status, income and occupational level, feeling of loneliness, place of residence, and food expenditure) in ≥60-year-old subjects, published in English among 2000–2018 (PROSPERO: CRD42019137097). The systematic review included 40 observational studies (34 cross-sectional and 4 cohort studies) and 16 cross-sectional studies in the meta-analysis (34,703 individuals) of malnutrition and MR in relation to low educational level (Odds Ratio (OR): 1.48; 95% Confidence Interval (CI): 1.33–1.64; p < 0.001), living alone (OR: 1.92; 95% CI: 1.73–2.14; p < 0.001), being single, widowed, or divorced (OR: 1.73; 95% CI: 1.57–1.90; p < 0.001), and low income level (OR: 2.69; 95% CI: 2.35–3.08; p < 0.001), and considering these four socioeconomic factors, malnutrition and MR is associated with them (OR: 1.83; 95% CI: 1.73–1.93; p < 0.001). Malnutrition and MR could be reduced by increasing economic level, supporting people living alone or being single, widowed, and divorced, and improving lifelong learning.

Community canteen services for the rural elderly: determining impacts on general mental health, nutritional status, satisfaction with life, and social capital

BACKGROUND

The Chinese government is piloting canteen services for older adults, but few studies have explored the influence of canteen services on the health of these older adults. This study aimed to investigate the impact of canteen services on older adults' general mental health, nutritional status, satisfaction with life, and social capital in rural areas.

METHODS

This study used a cross-sectional design. We selected 14 villages in Jinhua City, Zhejiang Province, China, including seven villages with canteen services and seven villages without canteen services. Participants were 284 senior older adults (aged 75~98), including 140 residing in villages with canteen services (Canteen Group [CG]) and 144 residing in villages without canteen services (Non-Canteen Group [NCG]). We also divided the CG into two sub-groups according to the funding sources (one receiving government support only, the other receiving government support plus enterprise donations). We used a self-designed questionnaire, including sociodemographics, diet-related items (e.g., satisfaction with the meals, diet expenditure, self-evaluation of meal nutrition), and the four scales including the Chinese version of the 12-item General Health Questionnaire (GHQ-12), the Chinese version of the Mini Nutritional Assessment Short-Form (MNA-SF), the Satisfaction with Life Scale (SWLS), and the Social Capital Questionnaire (SCQ).

RESULTS

The overall mental health, satisfaction with life, and social capital of the CG were better than the NCG (P <  0.05). The nutritional status of these two groups did not show a significant difference. Participants in the CG with financial support from local government and donations from an enterprise with a better dietary diversity exhibited a better nutritional status (P <  0.05); the average satisfaction with diet and self-evaluation of food nutrition of the CG were higher than the NCG (P < 0.05); the ratio of having a diet on time in the CG was higher than that of the NCG (P < 0.05).

CONCLUSION

The free canteen services provided by the government can improve older adults' satisfaction with life and diet, and mental health status and also enrich their social capital, but this still needs to be future evidenced. More financial support for canteen services is an essential component in promoting successful aging in China.

Depressive symptoms and nutritional status in the frail older adults

OBJECTIVES

The purpose of this study is to determine the relationship between depressive symptoms and nutritional status in the frail older adults.

METHODS

This study uses a cross-sectional, descriptive, and correlational design. A questionnaire was used to collect demographic data, and the Taiwan International Physical Activity Questionnaire Form Geriatric Depression Scale-Short Form Charlson Comorbidity Index, and Mini-Nutritional Assessment Short-Form were used to measure depression and nutritional status, respectively. Data were analyzed by independent-t tests, chi-square tests, spearman correlations, and multiple linear regressions.

RESULTS

Of the total of 94 frail older adults, 17 (18.09%) had depressive symptoms (GDS > 5). The average MNA-SF score was 11.38 (SD = 2.45), 31 (32.98%) participants had a risk of malnutrition and 12 (12.77%) were malnourished. Participants' reports of dissatisfaction with their lives (72.1%) and feeling terrible about their lives (58.14%) were associated with a risk of malnutrition. Elderly age, multiple comorbidities, and high level of depressive symptoms were at increased risk of malnutrition.

CONCLUSION

When clinicians are faced with a high-risk group, such as elderly patients with multiple comorbidities and depressive symptoms, they should perform an immediate assessment of nutritional status. If a risk of malnutrition is found, adequate nutrition and health care should be provided.

New insights into the anorexia of ageing: from prevention to treatment

PURPOSE OF REVIEW

Undernutrition in older adults is associated with frailty, functional decline, and mortality. The 'anorexia of ageing' is the age-related appetite and weight loss underpinning such undernutrition. This review examines the latest evidence for its prevention and treatment.

RECENT FINDINGS

Existing nutritional therapies for the anorexia of ageing include supporting nutritional intake with fortified food or supplements, including protein, omega-3 fatty acids, multivitamins, and vitamin D. The Mediterranean diet provides high fat intake and nutrient density in a moderate volume of colourful and flavoursome food and is strengthening in evidence for healthy ageing. Studies of the gut microbiome, which potentially regulates normal appetite by acting on the brain-gut communication axis, are pertinent. Utilisation of the genetic profile of individuals to determine nutritional needs is an exciting advancement of the past decade and may become common practice.

SUMMARY

Prevention or early treatment of the anorexia of ageing in older adults is critical. Latest evidence suggests that once significant weight loss has occurred, aggressive nutritional support may not result in improved outcomes.

The association between obesity indices and hypertension: Which index is the most notable indicator of hypertension in different age groups stratified by sex?

OBJECTIVE

This study aimed to investigate the most notable obesity index and its optimal cut-off point of hypertension in different age groups stratified by sexes among community residents in southern China.

METHODS

In this cross-sectional study, 620 men and 631 women aged 18-59 years were enrolled. The independent-samples t-test and chi-square test were conducted to analyze continuous and categorical variables, respectively. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis assessed the association between the obesity indices and hypertension risk.

RESULTS

Waist-stature ratio (WSR) and waist-hip ratio (WHR) were the most notable risk factors for hypertension in young men and women, respectively. The odds ratios (ORs) of hypertension risk increased with per standard deviation (SD) in WSR and WHR (WSR: OR = 2.877, 95% confidence interval [CI] = 1.602 to 5.167; WHR: OR = 10.683, 95%CI = 2.179 to 52.376). In the middle-aged group of both sexes, body mass index (BMI) was the most distinctive risk factor for hypertension, the ORs of hypertension risk increased with per SD in BMI (men: OR = 2.297, 95%CI = 1.683 to 3.136; women: OR = 1.810, 95%CI = 1.338 to 2.450). ROC curve analysis demonstrated WSR and PI were better indicators than other indices among young men, and WSR was the best marker among young women. However, BMI and WC were the most sensitive markers in middle-aged men and women, respectively.

CONCLUSIONS

In this Chinese population, the association of obesity indices and hypertension is inconsistent in different age groups and sexes. It is important to choose appropriate indicators for specific groups of people.