M O'Keeffe1, M Kelly1, E O'Herlihy2, P W O'Toole2, P M Kearney3, S Timmons4, E O'Shea4, C Stanton5, M Hickson6, Y Rolland7, C Sulmont Rossé8, S Issanchou8, I Maitre9, M Stelmach-Mardas10, G Nagel11, M Flechtner-Mors12, M Wolters13, A Hebestreit13, L C P G M De Groot14, O van de Rest14, R Teh15, M A Peyron16, D Dardevet16, I Papet16, K Schindler17, M Streicher18, G Torbahn18, E Kiesswetter18, M Visser19, D Volkert18, E M O'Connor20. 1. Department of Biological Sciences, University of Limerick, Limerick, Ireland. 2. School of Microbiology, University College Cork, Cork, Ireland; Alimentary Pharmabiotic Centre Microbiome Irelan, University College Cork, Cork, Ireland. 3. School of Public Health, University College Cork, Cork, Ireland. 4. Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland. 5. Alimentary Pharmabiotic Centre Microbiome Irelan, University College Cork, Cork, Ireland. 6. Institute of Health & Community, University of Plymouth, England, UK. 7. Gérontopôle de Toulouse, Institut du Vieillissement, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), UMR INSERM 1027, University of ToulouseIII, Toulouse, France. 8. Centre des Sciences du Goût et de l'Alimentation, AgroSup Dijon, CNRS, INRA, Université Bourgogne Franche-Comté, F-21000 Dijon, France. 9. GRAPPE USC 1422 INRA, Ecole supérieure d'Agricultures (ESA), Univ. Bretagne Loire, Angers, France. 10. German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany; Poznan University of Medical Sciences, Poznan, Poland. 11. Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany. 12. Division of Sports and Rehabilitation Medicine, Medical Center, Ulm University, Ulm, Germany. 13. Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany. 14. Division of Human Nutrition, Wageningen University & Research, Wageningen, the Netherlands. 15. Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand. 16. Université Clermont Auvergne, Institut National de la Recherche Agronomique (INRA), Unité de Nutrition Humaine (UNH), Centre de Recherche en Nutrition Humaine (CRNH), Auvergne, 63000, Clermont-Ferrand, France. 17. Department of Medicine III, Medical University of Vienna, Vienna, Austria. 18. Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany. 19. Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. 20. Department of Biological Sciences, University of Limerick, Limerick, Ireland; Alimentary Pharmabiotic Centre Microbiome Irelan, University College Cork, Cork, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland. Electronic address: eibhlis.oconnor@ul.ie.
Abstract
BACKGROUND & AIMS: Malnutrition in older adults results in significant personal, social, and economic burden. To combat this complex, multifactorial issue, evidence-based knowledge is needed on the modifiable determinants of malnutrition. Systematic reviews of prospective studies are lacking in this area; therefore, the aim of this systematic review was to investigate the modifiable determinants of malnutrition in older adults. METHODS: A systematic approach was taken to conduct this review. Eight databases were searched. Prospective cohort studies with participants of a mean age of 65 years or over were included. Studies were required to measure at least one determinant at baseline and malnutrition as outcome at follow-up. Study quality was assessed using a modified version of the Quality in Prognosis Studies (QUIPS) tool. Pooling of data in a meta-analysis was not possible therefore the findings of each study were synthesized narratively. A descriptive synthesis of studies was used to present results due the heterogeneity of population source and setting, definitions of determinants and outcomes. Consistency of findings was assessed using the schema: strong evidence, moderate evidence, low evidence, and conflicting evidence. RESULTS: Twenty-three studies were included in the final review. Thirty potentially modifiable determinants across seven domains (oral, psychosocial, medication and care, health, physical function, lifestyle, eating) were included. The majority of studies had a high risk of bias and were of a low quality. There is moderate evidence that hospitalisation, eating dependency, poor self-perceived health, poor physical function and poor appetite are determinants of malnutrition. Moderate evidence suggests that chewing difficulties, mouth pain, gum issues co-morbidity, visual and hearing impairments, smoking status, alcohol consumption and physical activity levels, complaints about taste of food and specific nutrient intake are not determinants of malnutrition. There is low evidence that loss of interest in life, access to meals and wheels, and modified texture diets are determinants of malnutrition. Furthermore, there is low evidence that psychological distress, anxiety, loneliness, access to transport and wellbeing, hunger and thirst are not determinants of malnutrition. There appears to be conflicting evidence that dental status, swallowing, cognitive function, depression, residential status, medication intake and/or polypharmacy, constipation, periodontal disease are determinants of malnutrition. CONCLUSION: There are multiple potentially modifiable determinants of malnutrition however strong robust evidence is lacking for the majority of determinants. Better prospective cohort studies are required. With an increasingly ageing population, targeting modifiable factors will be crucial to the effective treatment and prevention of malnutrition.
BACKGROUND & AIMS:Malnutrition in older adults results in significant personal, social, and economic burden. To combat this complex, multifactorial issue, evidence-based knowledge is needed on the modifiable determinants of malnutrition. Systematic reviews of prospective studies are lacking in this area; therefore, the aim of this systematic review was to investigate the modifiable determinants of malnutrition in older adults. METHODS: A systematic approach was taken to conduct this review. Eight databases were searched. Prospective cohort studies with participants of a mean age of 65 years or over were included. Studies were required to measure at least one determinant at baseline and malnutrition as outcome at follow-up. Study quality was assessed using a modified version of the Quality in Prognosis Studies (QUIPS) tool. Pooling of data in a meta-analysis was not possible therefore the findings of each study were synthesized narratively. A descriptive synthesis of studies was used to present results due the heterogeneity of population source and setting, definitions of determinants and outcomes. Consistency of findings was assessed using the schema: strong evidence, moderate evidence, low evidence, and conflicting evidence. RESULTS: Twenty-three studies were included in the final review. Thirty potentially modifiable determinants across seven domains (oral, psychosocial, medication and care, health, physical function, lifestyle, eating) were included. The majority of studies had a high risk of bias and were of a low quality. There is moderate evidence that hospitalisation, eating dependency, poor self-perceived health, poor physical function and poor appetite are determinants of malnutrition. Moderate evidence suggests that chewing difficulties, mouth pain, gum issues co-morbidity, visual and hearing impairments, smoking status, alcohol consumption and physical activity levels, complaints about taste of food and specific nutrient intake are not determinants of malnutrition. There is low evidence that loss of interest in life, access to meals and wheels, and modified texture diets are determinants of malnutrition. Furthermore, there is low evidence that psychological distress, anxiety, loneliness, access to transport and wellbeing, hunger and thirst are not determinants of malnutrition. There appears to be conflicting evidence that dental status, swallowing, cognitive function, depression, residential status, medication intake and/or polypharmacy, constipation, periodontal disease are determinants of malnutrition. CONCLUSION: There are multiple potentially modifiable determinants of malnutrition however strong robust evidence is lacking for the majority of determinants. Better prospective cohort studies are required. With an increasingly ageing population, targeting modifiable factors will be crucial to the effective treatment and prevention of malnutrition.
Authors: D Volkert; M Visser; C A Corish; C Geisler; L de Groot; A J Cruz-Jentoft; C Lohrmann; E M O'Connor; K Schindler; M A E de van der Schueren Journal: Eur Geriatr Med Date: 2019-11-20 Impact factor: 1.710
Authors: Jos W Borkent; Elke Naumann; Emmelyne Vasse; Ellen van der Heijden; Marian A E de van der Schueren Journal: Int J Environ Res Public Health Date: 2019-05-04 Impact factor: 3.390