Prevalence of malnutrition using harmonized definitions in older adults from different settings – A MaNuEL study

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Background & aims: Malnutrition is widespread among older people and related to poor outcome. Reported prevalences vary widely, also because of different diagnostic criteria used. This study aimed to describe prevalences in several populations of older persons in different settings using harmonized definitions. Methods: Available studies within the Joint Programming Initiative (JPI) Knowledge Hub ‘Malnutrition in the Elderly’ (MaNuEL) were used to calculate and compare prevalences of malnutrition indicators: low BMI (<20 kg/m 2 ; age-specific BMI <20 if age 65–<70 and <22 kg/m 2 if age ≥70 years), previous weight loss (WL), moderate and severe decrease in food intake, and combined BMI <20 kg/m 2 and/or WL in participants aged ≥65 years. Results: Fifteen samples with in total 5956 participants (59.3% women) were included: 7 consisting of community-dwelling persons, 2 studies in geriatric day hospitals, 3 studies in hospitalized patients and 3 in nursing homes. Mean age of participants ranged between 67 and 87 years. Up to 4.2% of community-dwelling persons had a BMI <20 kg/m 2 , 1.6 and 9% of geriatric day hospital patients, 4.5–9.4% of hospital patients and 3.8–18.2% of nursing home residents. Using age-specific cut-offs doubled these prevalences. WL was reported in 2.3–10.5% of community-dwelling persons, 6% and 12.6% of geriatric day hospital patients, 5–14% of hospitalized patients and 4.5–7.7% of nursing home residents. Severe decrease in food intake was recorded in up to 9.6% of community-dwelling persons, 1.5% and 12% of geriatric day hospital patients, 3.4–34.2% of hospitalized patients and 1.5–8.2% of nursing home residents. The criteria age-specific BMI and WL showed opposing prevalences across all settings. Compared to women, low BMI and moderate decrease in food intake showed low prevalences in men but similar prevalences were observed for weight loss and severe decrease in food intake. In half of the study samples, participants in a younger age group had a higher prevalence of WL compared to those of an older age group. Prevalence of BMI <20 kg/m 2 and WL at the same time did not exceed 2.6% in all samples. The highest prevalences were observed based on combined definitions when only one of the three criteria had to be present. Conclusions: Prevalences for different criteria vary between and within the settings which might be explained by varying functional status. The criteria used strongly affect prevalence and it may be preferable to look at each criterion separately as each may indicate a nutritional problem.

Original languageEnglish
Pages (from-to)2389–2398
Number of pages10
JournalClinical Nutrition
Issue number5
Early online date3 Nov 2018
Publication statusPublished - Oct 2019


The preparation of this paper was supported by the MalNutrition in the ELderly (MaNuEL) knowledge hub. This work is supported by the Joint Programming Initiative ‘A Healthy Diet for a Healthy Life’. The funding agencies supporting this work are (in alphabetical order of participating Member State): France: Agence Nationale de la Recherche (ANR); Germany: German Federal Ministry of Food and Agriculture (BMEL) through the Federal Office for Agriculture and Food (BLE), grant number 2815ERA09E ; Ireland: Department of Agriculture, Food and the Marine (DAFM) , and the Health Research Board (HRB) ; Spain: Instituto de Salud Carlos III , and the SENATOR trial ( FP7-HEALTH-2012-305930 ); The Netherlands: The Netherlands Organisation for Health Research and Development (ZonMw) .

FundersFunder number
Health Research Board
Department of Agriculture, Food and the Marine, Ireland
Agence Nationale de la Recherche
Instituto de Salud Carlos IIIFP7-HEALTH-2012-305930
Bundesministerium für Ernährung und Landwirtschaft
Bundesanstalt für Landwirtschaft und Ernährung2815ERA09E


    • Elderly
    • Malnutrition
    • Older adults
    • Older people
    • Prevalence


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