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Table 2 Factors associated with, and, determinants of malnutrition

From: Ageing rate of older adults affects the factors associated with, and the determinants of malnutrition in the community: a systematic review and narrative synthesis

First Author, Year, Country, Sample size, Age (mean (SD)) Sex (male %), Setting, Rate of Ageing Outcome (assessment method) Domain: Determinants Assessed FU time Statistical Analysis Key Results*
[OR (95% CI) p-value]
Cross-sectional studies
Chatindiara [49], 2019, New Zealand, N = 257, median 79 (IQR 7) 46.7, CD, U MN risk (MNA-SF) Demographic: age, marital status, ethnicity, sex, education
Social: Living situation, income source Food Intake: dysphagia risk (EAT-10), dental status Psychological: cognitive impairment (MoCA)
Physical function: ADLs, handgrip strength, gait speed, physical performance (FTSTS)
Disease-related: inflammation (CRP), number of comorbidities (> 5), polypharmacy (> 5 drugs), nutrition supplements use
N/A UV LR
MV LR
age (continuous) [1.09 (1.01–1.17) p = 0.033]; age < 85y [0.30 (0.1–0.79) p = 0.015]; normal swallowing [0.29 (0.09–0.97) p = 0.045]; healthy physical performance [0.22 (0.07–0.71) p = 0.012]; BMI [0.82 (0.74–0.91) p < 0.001]; fat mass [0.86 (0.78–0.94) p = 0.002]; % body fat [0.81 (0.72–0.90) p < 0.001]; FFMI [0.51 (0.34–0.77) p = 0.001]
Craven [23], 2018, Australia, N = 77, 73.3 (5.1) 60.0, CD, S MN risk (SCREEN 2) Demographic: age, sex, relationship status, education Food Intake: SR healthiness of diet Social: living arrangement, home care services
Disease-related: SR health, short form health survey (SF-12)- calculated PCS and MCS
N/A Multiple regression PCS (ẞ = 0.290, Seẞ = 0.065, p < 0.05); MCS (ẞ = 0.377, Seẞ = 0.073, p < 0.05)
Maseda [45], 2018, Spain, N = 749, 75.8 (7.2) 39.4%, CD attending SC, U-S MN risk (MNA-SF) Demographic: age, sex, education, marital status
Social: social support (OARS), living situation, loneliness
Physical function: IADL
Disease-related: QOL (WHOQOL-BREF)
N/A Multiple LR (forward stepwise) Total: female sex [0.6 (0.38–0.95) p = 0.028], social resources- total impairment [0.257 (0.08–0.85) p = 0.025], low physical health [1.676 (1.09–2.57) p = 0.018]
Males: single status [0.08 (0.02–0.34) p < 0.001], divorced/separated status [0.096 (0.02–0.39) p < 0.001], poor health satisfaction [4.31 (1.82–10.25) p < 0.001]
Females: social resources- mild impairment [0.51 (0.28–0.96) p = 0.036]
Ganhão-Arranhado [50], 2018, Portugal, N = 337, 78.4 (7.05) 37.7%, CD attending SC, N/A MN, MN risk (MNA) Demographic: age group, sex, marital status Social: income, SC attendance, motives for SC attendance, time of SC attendance, social risk, social net, social relationships Food Intake: food security Lifestyle: alcohol consumption, smoking status
Disease-related: SR health, SR health conditions (respiratory, liver and rheumatic diseases, angina, MI, high BP, high blood cholesterol, stroke, DM, cancer, depression)
Psychological: psychological stress
N/A UV regression, multinomial regression MN risk: cerebrovascular accident [4.04 (1.19–13.74) P < 0.05]; acute MI [2.12 (0.95–4.72) p < 0.05]; better perceived health status [− 0.54 (0.37–0.79) p < 0.05]; attending SC <5y [− 0.41 (0.16–1.04) p < 0.05]; loneliness [2.01 (1.06–3.81) p < 0.05] MN: food insecurity [1.73 (1.20–2.48) p < 0.05]; female [7.87 (1.33–46.72) p < 0.05]; age 74-85y [− 0.10 (0.02–0.57) p < 0.05]; depression [37.41 (2.06–679.55) p < 0.05]; DM [− 0.105 (0.01–1.06) p < 0.05]
Fjell [51], 2018, Norway, N = 166, 78.7 (3.3) 42%, CD, N/A MN risk (MNA-SF) Demographic: age, sex, education, marital status
Social: social support (OSLO 3-SSS) Lifestyle: exercise, alcohol consumption, smoking status
Other: vision, hearing, sleep problems Disease-related: SR pain, hypertension, hypercholesterolemia, eye disease, arthrosis, cancer
Psychological: depression
N/A MV LR poor SR health [5.77 (2.04–16.29) p = 0.001]
Grammatikopoulou [52], 2018, Greece, N = 207, 72.4 (8.5) 43.5%, CD, N/A MN risk (MNA) Demographic: age, education, marital status, waist circumference, BMI Social: income, receiving financial assistance,
Lifestyle: smoking status
Food intake: appetite (CNAQ), food security (HFIAS), dietary variety (HDDS), diet quality (MEDAS) Disease-related: catabolic disease (cancer/renal/lung), cardiometabolic disease (CVD, hypertension, angina, arrhythmia, hyperuricemia, microalbuminuria, retinopathy, neuropathy, or history of acute MI, stroke or coronary by-pass surgery)
N/A UV LR
MV LR
smoking [2.35 (1.09–5.08) p = 0.030]; not being married [2.10 (1.06–4.15) p = 0.033]; at risk for 5% WL [7.86 (4.07–15.18) p < 0.001]; food insecure [2.63 (1.21–5.75) p = 0.015]
Bakker [53], 2018, The Netherlands, N = 1325, median (IQR) 80 (77–84) 41.4%, CD attending GP, U-A MN (BMI < 20 kg/m2 and/or unintentional WL > 10% in 6 m and/or unintentional WL > 5% in 1 m) Demographic: age, sex, marital status, education, income
Social: living situation
Food intake: oral status, irregular dentist visits, oral hygiene, chewing problems, eating problems, speech problems, dental pain, dry mouth, insecurity with oral status, satisfaction with oral status Physical function: frailty (GFI), risk profile (frail, complex care needs, robust), ADL (Katz-15)
Disease-related: number of chronic conditions, polypharmacy (> 4 drugs), complex care (IM-E-SA), QOL (EQ-5D, EQ-VAS)
N/A UV LR
MV LR
health related QOL [0.97 (0.95–0.995) p = 0.015]
Jung [54], 2017, America, N = 171, 77.5 (8.2) 29.8%, Rural CD excluding mild- moderate dementia (SPMSQ), N/A MN risk (MNA-SF) Demographic: age, sex, race or ethnicity, marital status, education
Social: annual income, loneliness (UCLA loneliness scale)
Psychological: depression (GDS)
Disease-related: health status (SHPS),
Physical function: ADL, IADL (Self-Care Capacity Scale)
N/A SEM parameter estimate (standard error):
depression −0.30 (0.10) p = 0.001
van der Pols-Vijlbrief [40], 2016, The Netherlands, N = 300, 81.7 (7.6) 31.7%, CD, receiving home-care, A MN risk (SNAQ65+) Demographic: sex, age, education level, marital status
Social: living situation, social network (LSNS-6), social support, monthly income, financial ability to buy food (Determine your health checklist)
Food intake: eating alone, SR oral health, chewing surface (full vs partial/none) appetite (SNAQapp), taste/smell loss, adequate snacks per day (> 3)
Lifestyle: smoking status, alcohol consumption, PA
Disease-related: number chronic diseases (>  2), polypharmacy (> 5 drugs), hospitalisation in past 6 m, SR health, pain (NHP), nausea, intestinal problems, fatigue
Psychological: cognitive decline (IQCODE), depression (CES-D-10)
Physical functioning: ADL (BI), IADL, mobility (bed/chair bound, able to move around the house but unable to leave house independently, able to leave house independently, difficulty climbing stairs, ability to walk 100 m), falls
Other: visual function, hearing function
N/A MV LR unable to go outside [5.39 (2.46–11.81) p < 0.001], intestinal problems [2.88 (1.57–5.28) p = 0.001], smoking [2.56 (1.37–4.77) p = 0.003], osteoporosis [2.46 (1.27–4.76) p = 0.007], fewer than 3 snacks per day [2.61 (1.37–4.97) p = 0.003], ADL dependency [1.21 (1.09–1.35) p = 0.001], physical inactivity [2.01 (1.13–3.59) p = 0.018], nausea [2.50 (1.14–5.48) p = 0.022], cancer [2.84 (1.12–7.21) p = 0.028]
Lahmann [44], 2016, Germany,
N = 878, 78.5 (12.2)
37.1%, CD home care recipients, U-A MN risk (MUST, MNA-SF) Demographic: age, sex
Social: social living status
Disease-related: duration receiving home care
Physical functioning: functional capacity (BI)
N/A LR mental overload [8.1 (2.2–30.2) p < 0.01]; loss of appetite [3.6 (1.8–7.3) p < 0.01]; needs help with feeding [5.0 (2.3–11.2) p < 0.01]; dependent on feeding [1.9 (1.2–2.8) p < 0.01]
Maseda [55], 2016, Spain, N = 749, 75.8 (7.2) 39.4%, CD attending SC, N/A MN risk (MNA-SF) Demographic: sex, age, education level, BMI ≥25 kg/m2
Disease-related: co-morbidity (CCI), SR health, polypharmacy (> 5 drugs) Psychological: cognitive impairment (MMSE), depressive symptoms (GDS-SF) Physical functioning: frailty status
N/A muliple LR (forward stepwise likelihood ratio) Total: BMI > 25 kg/m2 [2.15 (1.28–3.61) p = 0.004]; polypharmacy [0.43 (0.28–0.68) p < 0.001]; poor SR health [0.32 (0.12–0.86) p = 0.023]; depressive symptoms [0.45 (0.23–0.86) p = 0.015]; pre-frail/frail [0.51 (0.28–0.93) p = 0.027]
Females: polypharmacy [0.52 (0.31–0.88) p = 0.014]; poor SR health [0.24 (0.09–0.66) p = 0.005]
Males: BMI > 25 kg/m2 [4.35 (1.61–11.75) p = 0.004]; polypharmacy [0.26 (0.11–0.62) p = 0.002]; depressive symptoms [0.10 (0.04–0.31) p < 0.001]
Krzyminska-Siemaszko [38], 2016, Poland, N = 3751, 77.4 (8.0) 52.8%, CD excluding cognitively impaired (MMSE), U-A MN risk (MNA-SF) Psychological: depression (GDS), cognitive impairment (MMSE)
Disease-related: polypharmacy (> 5 drugs), number chronic diseases (> 4), anaemia, peptic ulcer, stroke, Parkinson’s, cancer, pain
Food intake: edentulism
N/A Multiple LR Total: female sex [1.72 (1.45–2.04) p < 0.001], age [2.16 (1.80–2.58) p < 0.001], depression [11.52 (9.24–14.38) p < 0.001], dementia [1.52 (1.20–1.93) p < 0.001], multi-morbidity [1.27 (1.04–1.57) p = 0.02], anaemia [1.80 (1.41–2.29) p < 0.001], total edentulism [1.26 (1.06–1.49) p = 0.009]
Males: age [1.78 (1.40–2.27) p < 0.001], depression [12.80 (9.40–17.43) p < 0.001], dementia [1.58 (1.15–2.18) p = 0.005], anaemia [1.81(1.34–2.44) p < 0.001], total edentulism [1.31(1.04–1.66) p = 0.02]
Females: age [2.77 (2.11–3.61) p < 0.001], depression [10.80 (7.85–14.87) p < 0.001], multi-morbidity [1.35 (1.01–1.79) p = 0.04], anaemia [1.99 (1.30–3.07) p = 0.002]
Krzymińska-Siemaszko [56], 2015, Poland, N = 4482, 78.6 (8.5) 52.2%, CD, cognitively well (MMSE), N/A MN risk (MNA-SF) Demographic: age, sex, marital status, education
Social: living situation
N/A UV LR
MV LR
female [1.51 (1.19–1.92) p < 0.01]; every 10 y of life [2.18 (1.9–2.51) p < 0.01]; not married [1.50 (1.16–1.95) p < 0.01]
Gunduz [42], 2015,
Turkey,
N = 1030, 71.7 (7)
45.05%
CD, outpatients, cognitively well (MMSE > 17), U-S
MN (MNA) Demographic: age, sex, marital status, education, no children
Physical functioning: ADL, IADL
Psychological: depression (GDS)
Disease-related: comorbidities, polypharmacy (≥5 drugs)
N/A MV LR age [(1.007–1.056) p = 0.012]; low BMI [(0.702–0.796) p < 0.001]; low education level [(0.359–0.897) p = 0.015]; depression score [(1.104–3.051); p = 0.02]; > 4 comorbidities [3.5 (2.30–5.45) p < 0.001]
Bailly [57], 2015, France, N = 464, 77.41 (7.48) 31.3%, CD, N/A MN risk (MNA) Demographic: age
Social: living alone, financial satisfaction Food intake: pleasure of eating (HTAQ) Psychological: depressive symptoms (GDS) Disease-related: SR health Physical functioning: IADL
N/A SEM Males: depression β = − 0.38; greater pleasure eating β = 0.20; higher SR health β = 0.32; greater IADL score β = 0.16
Females: age β = − 0.13; depression β = − 0.33; greater pleasure eating 0.19; higher SR health β = 0.25; greater IADL score β = 0.32
Wham [58], 2015, New Zealand, Maori: N = 421, 82.8 (2.6) Non-maori: N = 516, 84.6 (0.5) 33%, CD, N/A MN risk (SCREEN 2) Demographic: age, sex
Lifestyle: PA (PASE), smoking status, alcohol consumption Social: residential care, living situation, life satisfaction, difficulty getting to shops, drives a car, occupation, deprivation index, income
Physical functioning: HGS, physical function (NEADL)
Disease-related: health related QOL (SF-12), stroke, MI
Psychological: cognitive function (3MS), depression (GDS-15)
N/A MV LR Maori: age [0.89 (0.79–0.99) p = 0.04]; primary education [3.41 (1.35–8.62) p = 0.03]; living alone (vs with others) [2.85 (1.34–6.05) p < 0.001]; living alone (vs with spouse) [4.10 (1.90–8.84) p < 0.001]; depression [1.30 (1.06–1.60) p = 0.01]
Non-Maori: male [0.49 (0.30–0.81) p = 0.005]; living alone (vs with spouse) [2.41 (1.42–4.08) p = 0.002]; SF-12 PCS [0.98 (0.96–0.99) p = 0.02]; depression [1.24 (1.08–1.43) p = 0.002]
Wham, 2015 [59], New Zealand, N = 67, 77.0 (1.5) 44%, CD Maori, N/A MN risk (SCREEN 2) Demographic: sex, age, education, marital status
Social: living situation, SR standard of living, importance of traditional food, importance of spirituality, use of traditional Māori as first language, living in large extended family area Disease-related: use of Māori medicine and healing
Psychological: depression (GDS-15)
Physical functioning: physical disability (NEADL)
N/A MV linear regression language and culture being a little to moderately important [ẞ = 6.70, p < 0.05]; availability of traditional food [ẞ = − 5.23, p < 0.01]; waist-to-hip ratio [ẞ = 20.17, p = 0.01]; depressive symptoms [ẞ = − 0.60, p = 0.02]
Toussaint [60], 2015, The Netherlands, N = 345, 67.1 (6.0) CD; N = 138, 80.9 (7.6) outpatients 46.4%, CD; 34.1%, outpatients, N/A MN risk (MNA-SF) Demographic: age, sex
Food intake: olfactory function
Lifestyle: smoking status
Psychological: cognitive function (CD: MMSE; outpatients: DemTect), depressive symptoms (GDS) Disease-related: comorbidities (CCI), polypharmacy (> 5 drugs)
N/A Linear regression CD: female [0.259 (0.031–0.488) p = 0.026] Outpatients: MMSE [ẞ (95% CI) p-value] [0.208 (0.059–0.357) p = 0.007]; GDS [− 0.378 (− 0.491- − 0.265) p < 0.001]
Rullier [61], 2014, France, N = 56, 70.9 (11.0) 27%, CD caregivers, N/A MN risk (MNA) Demographic: age, sex, education, caregiver relationship with patient
Social: living arrangements
Psychological: Trait anxiety (STAI Y-B), depression (CES-d), caregiver burden (Zarit Burden Interview)
Physical functioning: functional status (AGGIR)
N/A UV linear regression, multiple linear regression functional dependency [ẞ = − 0.336, (1.57–6.48) p = 0.002]; depressive symptoms [ẞ = − 0.365, (− 0.199- − 0.054) p = 0.001]; more apathetic patient with dementia [ẞ = − 0.342 (− 0.606- − 0.158) p = 0.001]
Torres [39], 2014, France,
Rural: N = 692, 75.5 (6.2)
Urban: N = 8691, 74.1 (5.5)
62% (rural), 39.7% (urban), CD, U MN risk (proxy MNA) Demographic: age, sex, education, marital status
Social: income
Physical function: ADL (Katz ADL scale)
Disease-related: polypharmacy (> 3 drugs)
N/A MV LR Rural: BMI < 21 kg/m2 [23.09 (5.1–104.46) p < 0.01], BMI 25–30 kg/m2 [0.41 (0.18–0.94) p < 0.01], BMI > 30 kg/m2 [0.16 (0.05–0.50) p < 0.01], dementia [3.04 (1.08–8.57) p = 0.04], polypharmacy [10.4 (2.59–4.20) p < 0.01]
Urban: females [1.46 (1.22–1.75) p < 0.001], widowed status [1.36 (1.12–1.66) p < 0.01], BMI < 21 kg/m2 [9.11 (7.39–11.23) p < 0.001], BMI 25–30 kg/m2 [0.74 (0.61–0.89) p < 0.001], depression [20.67 (17.46–24.49) p < 0.001], dementia [3.42 (2.22–2.58) p < 0.001], loss of ADL [6.94 (3.91–12.31) p < 0.001], polypharmacy [3.52 (2.95–4.20) p < 0.001]
Wham [41], 2014,
New Zealand, N = 3893, > 65y, Maori: >75y
46%, CD, U-S MN risk (ANSI) Demographic: age, sex, marital status, ethnicity, education
Social: WHOQOL- social, living situation
Physical functioning: ADLs (NEADL)
Psychological: depression (GDS)
Disease-related: chronic diseases, polypharmacy (> 3 drugs)
N/A UV LR
MV LR
female [1.41 (1.11–1.80) p = 0.006]; being Māori/other ethnicities vs European p = 0.002; not married p = 0.003; higher social health related QOL [0.94 (0.89–1.00) p = 0.036]; living with others related to low risk p < 0.0001; higher functional status [0.94 (0.90–0.99) p = 0.0182]; more depressive symptoms [1.10 (1.02–1.19)]; polypharmacy [1.34 (1.27–1.41) p < 0.0001]
Akin [62], 2014, Turkey, N = 845, 71.6 (5.6) 53.2%, urban CD, N/A MN risk (MNA) Demographic: sex, age, weight, BMI, WC, MUAC, education, marital status
Social: living situation, income Physical functioning: 4 min walking speed, fear of falling, IADL, ADL, urinary incontinence
Disease-related: SR chronic diseases (diabetes, hypertension, CHD, cerebrovascular disease, renal failure) Psychological: cognitive impairment (MMSE), depression (GDS)
N/A UV LR
MV LR
depressive mood [4.18 (2.85–6.11) p < 0.001]; diabetes [1.60 (1.09–2.35) p = 0.017]; moderate income [1.65 (1.08–2.49) p = 0.019]; low income [2.36 (1.48–3.77) p < 0.001]; living alone [2.49 (1.56–3.97) p < 0.001]; WC [0.98 (0.96–0.99) p = 0.015]; MUAC [0.93 (0.83–0.99) p = 0.014]; 4 min walking speed [1.16 (1.07–1.25) p < 0.001]
Geurden [63], 2014, Belgium,
N = 100, 75.2 (17)
22%, urban CD receiving homecare nursing, U-A MN risk [64] Demographic: age, sex
Food intake: eating problem, swallowing problem, loss of appetite, concern about eating problem/loss of appetite, GP informed about eating problem/loss of appetite, nutrition intervention prescribed, one warm meal every day Physical functioning: independent shopping, independent cooking, use of informal care, use of professional homecare
Disease-related: hospitalisation in last 3 m, days since last GP visit
N/A MV LR loss of appetite p < 0.001
Westergren [65], 2014, Sweden, N = 465, 78.5 (3.7) 46.5%, CD without cognitive deficits, N/A MN risk (SCREEN 2) Social: need for help with groceries, need for help with cooking
Physical functioning: falls (Downton falls risk index)
Disease-related: SR health Psychological: SR life satisfaction, anxiety/worries, low-spiritedness, fatigue/tiredness, sleeping well
N/A stepwise ordinal regression Linear (backward) regression living alone (females) [4.63 (2.85–7.52) p < 0.001]; living alone (males) [6.23 (3.35–11.59) p < 0.001]; age [0.86 (0.81–0.91) p < 0.001]; quite good SR health [2.03 (1.27–3.27) p = 0.003]; quite/very poor SR health [5.01 (2.23–11.23) p < 0.001]; often/always tired [2.38 (1.26–4.50) p = 0.008]; falls risk [1.21 (1.05–1.40) p = 0.010]
van Bokhorst-de van der Schueren [35], 2013, Netherlands,
N = 448, 80 (7)
38%,
outpatients living independently- in own home or assisted care facility, U
MN (MNA) Demographic: education, marital status, children
Lifestyle: smoking status, alcohol consumption
Physical functioning: ADLs, IADLs, falls, walking aid
Psychological: depression (GDS), cognitive impairment (MMSE)
Disease-related: polypharmacy (> 6 drugs), multi-comorbidities (> 4 diseases)
N/A UV LR
MV backward stepwise LR
alcohol use [0.4 (0.2–0.9) p < 0.05]; being IADL dependent [2.8 (1.3–6.4) p < 0.05]; depression [2.6 (1.3–5.3) p < 0.05]
de Morais [66], 2013, 8 European countries (Denmark, Germany, Italy, Poland, Portugal, Spain, Sweden and the UK),
N = 644, 74.8 (5.8)
49.8%, CD, U MN risk (Determine your health checklist) Demographic: BMI
Social: living situation
Food Intake: number of fruit and vegetables per day, chooses easy to chew food, changes in appetite
Disease-related: SR health, changes in health/health problems (SF-36)
N/A backward stepwise LR low BMI [ẞ (95% CI) p-value] [0.005 (0.001–0.01) p = 0.007]; number fruit and vegetables/day [− 0.21 (− 0.40- -0.03) p = 0.023]; general health [− 0.02 (− 0.03- -0.01) p = 0.006]; chooses easy to chew food [0.32 (0.15–0.49) p < 0.001]; living with another adult [2.82 (1.27–6.25) p = 0.011]; living alone [3.22 (2.00–5.16) p < 0.001]; changes in appetite [0.41 (0.20–0.85) p = 0.016]; changes in health/health problems [7.74 (4.02–14.90) p < 0.001]
Syrjälä [67], 2013, Finland, N = 157, > 75y 29.9%, CD, N/A MN risk (MNA-SF) Demographic: sex, education
Food Intake: unstimulated salivary flow, stimulated salivary flow, number of teeth, number of the occluding molars/pre-molars, dentures, SR chewing problems Social: use of a meal service
Disease-related: number of medications, DM
Psychological: cognitive function (MMSE) Physical functioning: IADLs
N/A MV LR Stimulated/unstimulated salivary flow not associated with MN risk
Simsek [68], 2013, Turkey, N = 650, 74.1 (6.3) 37.1%, CD living in a low socioeconomic area, U-S MN risk (MNA) Demographic: age, sex, marital status, education
Social: self-perceived economic status, social class, social insurance, ownership of house, personal income, living situation Food intake: food insecurity
Physical functioning: orthopaedic disability Disease-related: number chronic diseases, polypharmacy (> 5 drugs), SR health
N/A MV LR age [1.06 (1.02–1.10) p = 0.001]; number chronic diseases [1.41 (1.18–1.70) p < 0.001]; not being married [2.13 (1.31–3.46) p = 0.002]; SR poor economic status [2.49 (1.41–4.41) p = 0.002]; orthopaedic disability [1.95 (1.01–3.75) p = 0.047]; food insecurity [2.49 (1.48–4.16) p = 0.001]; poor SR health [4.33 (2.58–7.27) p < 0.001]
Smoliner [69], 2013, Germany,
N = 191, 79.6 (6.3)
28.3%, CD day hospital attendees without Parkinson’s disease or MMSE score < 20, N/A MN risk (MNA) Demographic: age
Food intake: olfactory function (Sniffin sticks test)
Psychological: cognitive function (MMSE) Disease-related: number of drugs Physical functioning: self-care capacity (BI)
N/A Linear regression BI [0.329 (0.03–0.08) p < 0.001]
Ramage-Morin [70], 2013, Canada, N = 15,669, 77 (No SD) 40.4%, CD, U MN risk (SCREEN 2-AB) Demographic: age, education
Food Intake: oral health
Social: income quintile, living situation, social support (Tangible Support MOS Subscale), social participation, driving status
Disease-related: number of medications Psychological: depressive symptoms (subset of questions from CIDI) Physical functioning: level of disability (HUI)
N/A MV LR Males: lowest income quintile [1.46 (1.16–1.85) p < 0.05]; living alone [2.86 (2.39–3.42) p < 0.05]; low social support [1.31 (1.06–1.62) p < 0.05]; infrequent social participation [1.46 (1.20–1.76) p < 0.05]; depression [2.77 (1.51–5.06) p < 0.05]; moderate/severe disability [1.59 (1.32–1.90) p < 0.05]; taking 2–4 drugs/day [1.31 (1.10–1.56) p < 0.05]; taking > 5 drugs/day [1.69 (1.17–2.44) p < 0.05]
Females: age [0.98 (0.97–0.99) p < 0.05]; living alone [1.85 (1.61–2.12) p < 0.05]; low social support [1.49 (1.26–1.75) p < 0.05]; infrequent social participation [1.43 (1.22–1.69) p < 0.05]; depression [2.21 (1.54–3.17) p < 0.05]; moderate/severe disability [1.82 (1.58–2.11) p < 0.05]; 2–4 drugs/day [1.42 (1.23–1.63) p < 0.05]; > 5 drugs/day [2.23 (1.71–2.91) p < 0.05]; fair/poor oral health [1.54 (1.27–1.88) p < 0.05]
Söderhamn [71], 2012, Norway,
N = 2106, 74.5 (6.9)
49.5, CD, N/A MN risk (NUFFE-NO, MNA-SF) Demographic: age, sex, marital status
Lifestyle: being active
Food Intake: eating sufficiently, preparing food, having access to meals Social: occupation, social support (receiving help to manage daily life), frequency of contact with family/neighbours/friends, loneliness, receiving home nursing, receiving home help
Disease-related: SR health, presence of chronic disease/handicap Psychological: feeling depressed
N/A UV LR
MV LR (forward stepwise conditional)
NUFFE-NO: single [2.99 (2.17–4.13) p < 0.001]; professional/white collar worker [0.50 (0.36–0.69) p < 0.001]; depressed [1.71 (1.07–2.76) p = 0.026]; chronic disease/handicap [2.15 (1.57–2.96) p < 0.001]; being active [0.26 (0.17–0.39) p < 0.001]; eating sufficiently [0.07 (0.02–0.21) p < 0.001]; receiving home nursing [2.99 (1.37–6.56) p < 0.006]; receiving family help [1.92 (1.40–2.64) p < 0.001]; contact with neighbours [0.73 (0.61–0.89) p = 0.001]
MNA-SF: female [1.70 (1.18–2.43) p = 0.004]; receiving help [1.67 (1.02–2.75) p = 0.042]; perceived helplessness [2.39 (1.41–4.02) p = 0.001]; chronic disease/handicap [1.56 (1.08–2.25) p = 0.019]; eating sufficiently [0.18 (0.08–0.39) p < 0.001]; receiving home help [1.88 (1.25–2.81) p = 0.006]; receiving family help [1.88 (1.25–2.81) p = 0.002]; having contacts with family [0.59 (0.40–0.86) p = 0.006]; having contacts with neighbours [0.76 (0.62–0.93) p = 0.008]
Nykänen [72], 2012, Finland, N = 696, 81 (4.6) 30.6%, CD, N/A MN risk (MNA-SF) Demographic: age, sex, education Food Intake: dry mouth/chewing problems Social: living situation
Disease-related: SR health, number of drugs used regularly
Psychological: depressive symptoms (GDS), cognitive impairment (MMSE) Physical functioning: ADLs, IADLs, ability to walk 400 m independently
N/A UV regression MV regression (stepwise, forward selection) dry mouth/chewing problems [2.01 (1.14–3.54) p < 0.05]; IADL [0.85 (0.75–0.96) p < 0.05]; MMSE [0.90 (0.85–0.96) p < 0.05]
Tomstad [73], 2012, Norway, N = 158, 73.2 (6.9) 41.8%, CD, N/A MN risk (NUFFE) Demographic: age, marital status Physical functioning: self-care (SASE) Social: attitude to life (SOC), living situation, social support, receiving home help, perceived helplessness Lifestyle: being active Psychological: perceiving life as meaningful N/A MV LR (forward stepwise conditional) living alone [7.46 (2.58–21.53) p < 0.001]; receiving help regularly [9.32 (2.39–36.42) p = 0.001]; being active [0.17 (0.04–0.65) p = 0.010]; perceived helplessness [6.87 (1.44–32.78) p = 0.016]
McElnay [74], 2012, New Zealand, N = 473, 74.0 (no SD) 43.8%, CD, N/A MN risk (SCREEN 2) Demographic: ethnicity (Maori vs not), sex, age
Social: living situation
N/A UV LR
MV LR (model 1, forced entry; model 2, forward stepwise)
Model 1: Maori [5.21 (1.52–17.90) p = 0.009]; living alone [3.53 (2.06–6.06) p < 0.001] Model 2: Maori [6.44 (1.87–22.11) p = 0.003]
Zeanandin [75], 2012, France, N = 190, 81.2 (4.4) 37.4%, CD, N/A MN risk (MNA-SF) Demographic: BMI
Food intake: restrictive diet type, diet duration, diet compliance
Disease-related: comorbidities, polypharmacy
N/A UV LR
MV LR
absence of diet [0.3 (0.1–0.6) p < 0.001]; increased BMI [1.3 (1.2–1.5) p < 0.001]; on a restrictive diet [3.6 (1.8–7.2) p < 0.001]
Samuel [76], 2012, America,
N = 679, 74.06 (2.8)
0%, CD, N/A MN risk (MNA-SF) Demographic: age, race, marital status, education
Social: financial strain, annual income, participation in food stamps program, difficulty driving Disease-related: congestive heart failure, cancer
N/A MV LR Enough to make ends meet model: not enough to make ends meet [4.08 (1.95–8.52) p < 0.05]; income < $6000/m [2.54 (1.07–5.99) p < 0.05]; age [1.12 (1.03–1.22) p < 0.05]
Lack of income for food model: lack of money fairly/very often [2.98 (1.15–7.73) p < 0.05]; income < $6000/m [2.77 (1.10–6.98) p < 0.05]; age [1.11 (1.02–1.21) p < 0.05]
Timpini [77], 2011,
Italy, N = 698, 75.6 (6.4)
41.5%, CD, U-S MN risk (MNA-SF) Demographic: education
Lifestyle: PA
N/A UV LR
MV LR models
low education [2.9 (1.2–6.8) p < 0.05]; lack of PA- model 1 [4.5 (2.2–9.8) p < 0.05],
model 2 [4.8 (1.9–11.8) p < 0.05]
Kvamme [78], 2011, Norway,
N = 3111, 71.6 (5.45)
50%, CD, N/A MN, MN risk [64] Psychological: anxiety and depression (SCL-10) N/A LR anxiety/depression symptoms with MN risk: males [3.9 (1.7–8.6) p < 0.05], females [2.5 (1.3–4.9) p < 0.05]
Fagerstrom [79], 2011, Sweden, N = 1230, 76.1 (9.9) 42.4%, CD, N/A MN (BMI < 23 kg/m2) Demographic: age, sex, living arrangement Psychological: cognitive impairment (MMSE)
Physical functioning: ADLs
N/A UV LR
MV LR (backward likelihood ratio stepwise)
age [1.02 (1.00–1.04) p = 0.032]; being female [2.20 (1.55–3.11) p < 0.001]; moderate/severe cognitive impairment [3.32 (1.77–6.24) p < 0.001]
Wham [80], 2011, New Zealand, N = 51, 82.4 (1.7) 29.0%, CD, N/A MN risk (SCREEN 2) Demographic: age, sex, ethnicity Social: living situation, access to a car, socioeconomic deprivation, strength of social support/network (PANT), loneliness (EASY-Care)
Psychological: depression (EASY-Care), cognitive impairment (EASY-Care) Physical functioning: disability score (EASY-Care)
Disease-related: SR health (EASY-Care),
N/A multiple linear regression good SR health [coefficient (SE) p-value] [− 4.31 (1.98) p = 0.035]; poor SR health [− 10.23 (2.31) p < 0.001]; British/Canadian country of origin [− 5.55 (2.14) p = 0.013]; change in living situation, previously with spouse [− 5.31 (2.2) p = 0.02]; good SR health*some evidence depression [12.40 (5.24) p = 0.023]; poor SR health*some evidence depression [14.96 (5.84) p = 0.014]
Romero-Ortuno [81], 2011, Ireland, N = 556, 72.5 (7.1) 30.2%, CD independently mobile (with/without walking aid) outpatients, N/A MN risk (MNA) Demographic: age, sex
Social: social support (LSNS-18), deprivation scale (NIDS), personality traits (EPI), loneliness (De Jong gierveld) Physical functioning: mobility (TUG) Disease-related: comorbidities (CCI) Psychological: cognitive function (MMSE), depressive symptoms (CES-d)
N/A MV LR TUG [1.11 (1.05–1.18) p < 0.001]; LSNS-18 [0.96 (0.93–0.99) p < 0.005]; NIDS [1.20 (1.03–1.39) p < 0.018]; age [1.07 (1.01–1.13) p < 0.032]
Soderhamn [82], 2010, Sweden, N = 1461, > 75 y 45.2, 98% CD, 2% institutionalised, N/A MN risk (NUFFE) Demographic: sex, marital status, education
Social: living setting
Physical function: help to manage daily life Disease-related: perceived health
N/A MV stepwise LR living alone [4.85 (3.59–6.56) p < 0.05]; receiving help to manage daily life [2.55 (1.77–3.66) p < 0.05]; perceived health [0.96 (0.96–0.97) p < 0.05]
Sorbye [48], 2008, 11 European sites (Czech Republic, Denmark, Finland, France, Italy, Iceland, Norway, Sweden, Netherlands, Germany, UK), N = 4010, 82.5 (7.3) 26%, CD receiving home care or nursing care services, N/A unintentional WL (> 5% in past 30 days or > 10% in past 180 days) Demographic: age, sex, severe MN Food intake: < 1 meal/day, insufficient food and fluid intake, insufficient fluid intake, oral problems with swallowing food, pain in the mouth while eating, dry mouth, tube feeding, reduced appetite, vomiting Disease-related: constipation, diarrhoea, daily pain, pain disrupts normal activity, pressure ulcers, SR health, terminal prognosis < 6 m Physical functioning: fall last 90 days, IADL dependency > 3 (index 0–7), ADL dependency > 3 (index 0–8) Other: vision decline past 90 days Social: reduced social activity, feels lonely, not out of house in last week Psychological: risk of depression ≥1 (index 0–9), cognition [CPS > 3 (hierarchy scale 0–6)] N/A MV LR (Wald forward stepwise) < 1 meal/day [4.2 (2.8–6.4) p < 0.05]; reduced appetite [2.5 (1.9–3.4) p < 0.05]; severe MN [7.1 (4.2–11.9) p < 0.05]; reduced social activity [2.0 (1.6–2.5) p < 0.05]; hospitalisation past 90 days [2.1 (1.6–2.7) p < 0.05]; eating less [2.8 (1.8–4.4) p < 0.05]; constipation [1.9 (1.3–2.7) p < 0.05]; falls [1.5 (1.2–1.9) p < 0.05]; oral problem swallowing food [2.8 (1.8–4.4) p < 0.05]; flare-up of chronic disease [1.5 (1.1–2.1) p < 0.05]; pressure ulcers [1.5 (1.2–1.9) p < 0.05]; daily pain [1.3 (1.0–1.6) p < 0.05]
Gil-Montoya [83], 2008, Spain,
N = 2860, 73.6 (6.8)
42, 88.5% CD, 11.5% institutionalised, N/A MN risk (MNA) Demographic: age, sex, institutionalization Food intake: dental status, oral health QOL (GOHAI score) N/A multiple linear regression age [(1.01–1.04) p < 0.001]; male [(1.19–1.66) p < 0.001]; institutionalisation [(1.16–1.92) p < 0.05]; GOHAI [(0.93–0.95) p < 0.001]
Roberts [37], 2007, Canada, N = 839, 79.6 (no SD) 31.3%, CD with no more than MCI, N/A MN risk (ENS) Demographic: sex, age, education, marital status
Social: living situation
Physical functioning: physical limitations (walking), ADLs/IADLs a
Psychological: cognitive impairment (MMSE)
Disease-related: chronic diseases (CDS), SR health status
longitudinal subset (N = 335 at risk at baseline): 1 y FU Cross-sectional:
simple LR, MV Longitudinal:
simple LR, MV
Cross-sectional: age [1.05 (1.00–1.09) p < 0.05]; ADL [1.59 (1.02–2.49) p < 0.05]; IADL ‘need’ [1.45 (1.02–2.07) p < 0.05]; psychological distress (feelings of depression, anxiety, irritability, impaired cognition) [2.24 (1.22–4.09) p < 0.05]; current SR health [3.34 (2.01–5.54) p < 0.05]
Longitudinal: SR health among those at low MN risk [OR = 3.30, p < 0.05]
Martin [84], 2007, America,
N = 130, 78 (2.3)
45.4%, CD attending VA outpatient clinics with BMI < 24 kg/m2, without dementia (MMSE)/ cancer/heart failure, U MN (BMI < 19 kg/m2) Demographic: age, sex, ethnicity, marital status, education, religion
Social: annual income, social support, type of residence
Lifestyle: PA, smoking status, alcohol consumption
Disease-related: medication use, comorbidities, hospitalisation, doctor visits
Psychological: depression (GDS)
N/A MV LR having an illness/condition which changed the type/amount of food eaten [4.7 (1.6–13.1) p < 0.05], unintentional WL of > 10 lb. in past 6 m [4.0 (1.5–10.7) p < 0.05], requiring assistance with travel [4.0 (1.4–11.3) p < 0.05]
Chen [36], 2005, America,
N = 240, 81.7 (8.7)
21.7, CD, U-A MN risk (MNA) Demographic: age, sex, marital status, ethnicity, education, religion
Social: living situation, income levels, social support (SSQSF), loneliness (UCLA Loneliness Scale)
Disease-related: comorbidities (Co-morbidity checklist), medication use
Food Intake: oral health (BOHSE, GOHAI)
Psychological: depression (GDS)
Physical functioning: physical and social competence (ESDS)
N/A MV hierarchical LR annual income > $10,000 [0.40 (0.19–0.84) p = 0.014], depression [1.12 (1.03–1.21) p = 0.008], functional status [1.09 (1.03–1.15) p = 0.005], self-perceived oral health [0.87 (0.78–0.97) p = 0.009]
Locher [85], 2005, America,
N = 1000, 75.3 (no SD)
50.1%, CD, U MN risk (Determine your health checklist) Demographic: age, education, marital status Social: rural location, income, reliable transportation, social support, y at address, religious attendance, fear attack, experience discrimination, veteran Physical functioning: mobility (Independent life-space) N/A multiple linear regression Black women: reliable transportation [ẞ = 0.196, t = 2.896, p = 0.004]; independent life-space [ẞ = − 0.344, t = − 4.626, p < 0.001]; income [ẞ = − 0.185, t = − 2.227, p = 0.027]
Black men: independent life-space [ẞ = − 0.245, t = − 3.415, p = 0.001]; being married [ẞ = − 0.245, t = − 3.415, p = 0.001]; religious attendance [ẞ = − 0.185, t = − 2.781, p = 0.006]; fear attack [ẞ = 0.143, t = 2.300, p = 0.023]; experienced discrimination [ẞ = 0.157, t = 2.450, p = 0.015] White women: independent life-space [ẞ = − 0.297, t = − 4.121, p < 0.001]; social support scale [ẞ = 0.156, t = 2.425, p = 0.016]; income [ẞ = − 0.216, t = − 2.259, p = 0.025] White men: reliable transportation [ẞ = 0.195, t = 2.957, p = 0.003]; independent life-space [ẞ = − 0.282, t = − 4.151, p < 0.001]
Johnson [86], 2005, Canada, N = 54, 81 (no SD) 48%, CD, N/A MN risk (MNA) Social: perceived social support (LSNS) Psychological: life satisfaction (13-item Life Satisfaction Index Form Z), depression (GDS) N/A Hierarchical regression analysis (forward selection) depression (B = − 0.534, p = 0.001), social support (B = 0.310, p = 0.013)
Weatherspoon [87], 2004, America, N = 324, >  60 y (no mean) 25%, CD, U MN risk (Determine your health checklist) Demographic: age, sex, ethnicity
Social: use of home health aide/caregiver Disease-related: SR health, frequency of doctor, clinic and dentist visits, use of visiting nurse, number of nutritionist/dietitian visits, intake of laxatives, sleep medication, tranquilizers, antacids
Food intake: intake of vitamins, fibre supplements, fluid intake
N/A MV LR rural location [2.70 (1.2–5.9) p = 0.01]; poor SR health [4.28 (1.02–17.9) p = 0.04]; not visiting GP regularly [0.34 (0.15–0.77) p = 0.01]
Sharkey [88], 2004, America,
N = 908, 78.2 (8.2)
37.8%, CD MOW recipients, A MN risk (Nutritional Health Screen- modified version of Determine your health checklist) Demographic: age, sex, ethnicity (Mexican-American vs not), marital status Social: rural area of residence, poverty guideline
Disease-related: multi-comorbidities (> 3 comorbidities)
Physical-functioning: ADLs, IADLs
N/A MV LR Mexican-American [1.47 (1.05–2.06) p = 0.026]; rural [1.49 (1.02–2.18) p = 0.04]; not being married [1.77 (1.33–2.36) p = 0.001]; worst IADL score [0.44 (0.27–0.70) p = 0.001]; worst ADL score [1.74 (1.12–2.71) p = 0.014]
Margetts [89], 2003, UK, N = 1632, > 65 y (no mean given) 50.7%, CD: 82.5%, institutionalised: 17.5%, N/A MN risk (MAG tool: high risk = BMI < 18.5 kg/m2 or BMI 18.5–20.0 kg/m2 with WL of > 3.2 kg or BMI > 20.0 kg/m2 with WL > 6.4 kg; medium risk = BMI 18.5–20.0 kg/m2 with < 3.2 kg (unless no long-term illness and no WL) or BMI > 20 kg/m2 and WL 3.2–6.4 kg; low risk = BMI > 20 kg/m2 with no WL (< 5% BW) Demographic: age, region, setting
Disease-related: SR health, long standing illness, hospitalisation in the last y
N/A MV LR Males: hospitalisation in past y [1.83 (1.06–3.16) p < 0.05]; being institutionalised [2.17 (1.22–3.88) p < 0.05]; longstanding illness [2.34 (1.20–4.58) p < 0.05]; age > 85 y [2.64 (1.30–5.33) p < 0.05]; from northern England/Scotland vs southeast England/London [2.81 (1.54–5.11) p < 0.05]
Females: poor SR health [2.82 (1.25–6.38) p < 0.05]; longstanding illness [2.98 (1.58–5.62) p < 0.05]
Sharkey [90], 2002, America, N = 729, 79 (no SD) 0%, CD receiving MOW, N/A MN risk (Determine your health checklist) Demographic: age, race
Social: living situation, income, MOW service use
Physical functioning: functional disability (ADL)
N/A UV ordered LR
MV ordered LR
Total sample: being black [coefficient, p-value] [0.62, p < 0.001]; age 60–74 y [0.80, p < 0.001]; poverty [0.43, p < 0.001]; living alone [0.51, p < 0.001]; increasing m using MOW service [0.096, p < 0.05]
Black women: aged 60–74 y [0.72, p < 0.01] White women: living alone [0.76, p < 0.001]; poverty [0.47, p < 0.05], aged 60–74 y [0.86, p < 0.001]
Pearson [91], 2001, towns within 9 European countries (Belgium, Denmark, France, France, Italy, the Netherlands, Portugal, Spain, Switzerland, Poland), N = 627, 80–85 y (no mean/SD given) 45.9%, CD, N/A MN risk (MNA) Demographic: sex, living situation
Psychological: cognitive impairment (MMSE)
Physical functioning: ability to complete all self-care ADLs
N/A MV LR Total: diminished cognitive function [2.10 (1.98–2.22) p < 0.05]; diminished self-care ability [2.44 (2.32–2.56) p < 0.001] Males: diminished self-care ability [2.93 (2.76–3.10) p < 0.01]; diminished cognitive function [2.65 (2.46–2.84) p < 0.05]; living alone [1.23 (1.06–1.40) p < 0.05]
Females: diminished self-care ability [2.06 (1.90–2.22) p < 0.05]; diminished cognitive function [1.77 (1.61–1.93) p < 0.05]
Longitudinal studies
Bardon [46], 2018, Ireland, N = 1841, 72 (4.99) 49.8%, CD dementia free (MMSE), S MN (BMI < 20 kg/m2 or WL > 10% over 2 y) Demographic: age, sex, education, marital status
Food intake: appetite
Lifestyle: smoking status, alcohol consumption, PA
Social: living situation, social support
Disease-related: number chronic disease (> 2), polypharmacy (> 5 drugs), pain, SR health, hospitalisation 1 y before baseline, hospitalisation 1 y before FU
Physical functioning: falls 1 y before baseline, falls during FU, difficulty climbing stairs without rest, difficulty walking 100 m without rest, HGS
Psychological: depression (CES-D), cognitive impairment (MMSE)
2 y UV LR
MV LR
Total: unmarried/separated/divorced status [1.84 (1.21–2.81) p < 0.05], hospitalisation 1 y before FU [1.62 (1.14–2.30) p < 0.05], difficulty climbing stairs [1.56 (1.12–2.17) p < 0.05], difficulty walking 100 m [1.83 (1.13–2.97) p < 0.05]
Males: falls during FU [1.62 (1.01–2.59) p < 0.05], difficulty climbing flight stairs [2.25 (1.44–3.50) p < 0.05], hospitalisation 1 y before FU [1.73 (1.08–2.77) p < 0.05]
Females: social support [2.44 (1.19–4.99) p < 0.05], cognitive impairment [2.29 (1.04–5.03) p < 0.05]
Hengeveld [92], 2018, America, N = 2212, 74.6 (2.9) 49.6%, well functioning CD, N/A MN (PEM: BMI < 20 kg/m2 and/or involuntary WL ≥5% in the past y) Demographic: age, sex, race, education, BMI
Social: living situation, income Lifestyle: PA, smoking status, alcohol consumption Food Intake: diet quality (HEI), protein intake (g/kg BW/d), appetite, biting/chewing difficulty Disease-related: SR health status, chronic diseases (cancer, DM, CVD, chronic pulmonary disease, osteoporosis) Psychological: cognitive function (modified MMSE), depression
yearly for 4 y MV Cox proportional hazards analysis Developing PEM during 4 y of FU: low energy intake [0.71 (0.55–0.91) p < 0.05] Having persistent PEM (PEM at 2 consecutive FUs): poor HEI score [0.97 (0.95–0.99) p < 0.05]; low EI [0.56 (0.36–0.87) p < 0.05]; low protein intake [1.15 (1.03–1.29) p < 0.05]
Serra-Prat [93], 2012, Spain, N = 254, 78.2 (5.6) 53.5%, CD, U-S MN risk (MNA) Demographic: age
Food Intake: impaired efficacy of swallow (impaired labial seal, oral or pharyngeal residue, piecemeal deglutition)
Physical functioning: functional capacity (BI)
1 y MV LR No significant results when adjusted for age
Schilp [94], 2011, Netherlands,
N = 1120, 74.1 (5.7)
48.5%, CD (97.9%) and institutionalised (2.1%), S MN (BMI < 20 kg/m2 or SR invol. WL ≥ 5% in previous 6 m) Demographic: sex, age, education
Food Intake: appetite, chewing difficulties
Lifestyle: smoking status, alcohol consumption, PA (LAPAQ)
Social: loneliness
Physical functioning: limitations climbing stairs, physical performance (chair stands, tandem stand and walk test)
Psychological: cognitive impairment (MMSE), depression (CESD), anxiety (HADS)
Disease-related: medication use, SR pain, chronic diseases
3, 6, 9 y cox proportional-HR
UV LR
MV LR
poor appetite [1.63 (1.02–2.61) p < 0.05]; difficulties climbing stairs (in those < 75 y only) [HR (95% CI) 1.91 (1.14–3.22)]; one or two medications (vs none in females only) [HR (95% CI) 0.39 (0.18–0.83) p < 0.05]
Jyrkka [78], 2011, Finland, N = 294, 81.3 (4.5) 31%, CD (94.6%) and institutionalised (5.4), U MN risk (MNA-SF) Demographic: age, sex, education, residential status (home vs institution) Physical function: functional comorbidity index
Disease-related: polypharmacy, SR health
3 y Linear mixed model approach excessive polypharmacy 0.62 points lower MNA-SF scores (p < 0.001); age [ẞ (standard error) p-value; − 0.04 (0.02) p = 0.016]; institution [− 1.89 (0.25) p < 0.001]; moderate [− 0.27 (0.11) p = 0.016] and poor [− 1.05 (0.17) p < 0.001] SR health status
Johansson Y [43], 2009, Sweden, N = 579, 75 y and 80 y cohort 52.5%, CD, N/A MN risk (MNA) Demographic: age
Physical functioning: HGS, physical mobility (NHP), walking limitations, limitations climbing stairs, physical health (PGC-MAI) b
Psychological: depression (GDS), cognitive impairment (MMSE)
Disease-related: SR health, pain (NHP)
75 y olds: yearly for 5 y
80 y olds: yearly for 3 y
forward stepwise multiple LR higher age p = 0.005 at 1 y; HGS [0.938 (0.91–0.97) p < 0.001]; physical health [0.65 (0.55–0.76) p < 0.001] predicted risk of MN at baseline; more depression symptoms [1.178 (1.07–1.30) p = 0.001] 1 y predictor; depressive symptoms*males [OR 1.26] depressive symptoms*females [OR 1.03]; lower SR health [0.432 (0.27–0.70) p = 0.001]
Johansson L [95], 2009, Sweden, N = 258, 74.2 (2.55) 49.6%, CD, A MN risk (MNA) Social: social support
Physical functioning: ADLs
Psychological: cognitive impairment (MMSE)
Disease-related: SR health, hospitalisation
4, 8, 12 y UV LR
MV LR
Total: MOW use [OR 19.6, p < 0.001];
Males; use of MOW [OR 21.9, p < 0.01]; MMSE score (cut-off 23/24) [12.9 (2.9–56.7) p < 0.01]; poorer SR health compared to 4 y ago [OR 5.1, p < 0.05]
Females: increased MOW use [OR 31.0, p < 0.01]; hospital stay during the past 2 m [OR 7.1, p < 0.05]
Keller [96], 2006, Canada, N = 367, 78.7 (8.0) 24%, vulnerable CD c, A MN risk (SCREEN) Social: social support- MOW use 1.5 y multiple linear regression MOW use associated with a 1.6-point higher score in SCREEN at FU [(0.02–3.23) p = 0.04]; increasing help making meals [(2.91–0.49) p = 0.006]
Visvanathan [47], 2003, Australia, N = 250, 79.45 (no SD) 30.8%, CD receiving domiciliary care (all had MMSE > 24), A MN risk (MNA) Demographic: age
Lifestyle: smoking status
Social: MOW use, amount of domiciliary care per m
Disease-related: comorbidities, health status and QOL (SF-36)
1 y UV LR binomial analysis hospitalisation [RR 1.51 (1.07–2.14) p = 0.015], > 2 emergency hospitalisation [RR 2.96 (1.17–7.50) p = 0.022], > 4 week hospitalisation [RR 3.22 (1.29–8.07) p = 0.008], falls [RR 1.65 (1.13–2.41) p = 0.013], WL [RR 2.63 (1.67–4.15) p < 0.001], >  2 hospitalisations [RR 2.11 (1.04–4.29) p = 0.039], emergency hospitalisation [RR 1.99 (1.28–3.11) p = 0.002]
Shatenstein [86], 2001, Canada, N = 584, > 70 y (no mean given) 40.4%, CD, N/A MN risk (WL > 5% baseline weight) Demographic: age, study region, WL Social: ability to shop, bereavement Psychological: cognitive diagnosis at FU, depression, SR interest in life Food Intake: ability to eat independently, loss of appetite Physical functioning: frailty 5 y MV LR (backward stepwise) consistent appetite [0.22 (0.12–0.42) p < 0.001]; loss of interest in life [0.56 (0.34–0.90) p = 0.017]
Ritchie [97], 2000, America,
N = 563, Males: 77.3 (4.7), Females: 78.1 (5.3)
43%, CD, N/A MN (WL > 10% BW) Demographic: age, sex
Lifestyle: smoking status, alcohol consumption, PA
Food Intake: edentulousness, wears full prostheses, % sites with gingival bleeding, mean attachment loss, mean recession Disease-related: > 2 comorbidities Physical functioning: ADLs Psychological: depression
1 y UV LR
MV LR
female sex [3.77 (1.71–8.33) p < 0.05], baseline weight [1.02 (1.01–1.03) p < 0.05]; dependent in > 1 ADL [2.27 (1.08–4.78) p < 0.05]; edentulousness [2.03 (1.05–3.96) p < 0.05]
Systematic Review
O’Keeffe [98], 2018, Canada, Denmark, Finland, Israel, Japan, Netherlands, Spain, Sweden, Taiwan, USA,
23 studies N = 108–4512, 74 (12)
17–53.5%, N = 15 CD, N = 3 institutionalised, N = 3 acute hospital, N = 2 CD and institutionalised combined, N/A MN (any definition/screening tool) Food intake: appetite, complaints about taste, nutrient intake/modified texture diet, hunger, thirst, dental status, chewing, mouth pain, gum issues, swallowing, eating dependency/difficulty feeding Psychological: cognitive function, depression, psychological distress, anxiety Social: social support, living situation, transport, loneliness, wellbeing, MOW, vision and hearing
Disease-related: medication use, polypharmacy, hospitalisation, comorbidities, constipation, SR health Physical functioning: ADLs
Lifestyle: smoking status, alcohol consumption, PA
24 weeks- 12 y Mixed Moderate evidence for association: hospitalisation, eating dependency, poor SR health, poor physical function, poor appetite Moderate evidence for no association: chewing difficulties, mouth pain, gum issues, comorbidity, hearing and vision impairments, smoking, alcohol consumption, low PA, complaints about taste of food, specific nutrient intakes
Low evidence determinants: modified texture diets, loss of interest in life, MOW access
Low evidence not determinants: psychological distress, anxiety, loneliness, access to transport, wellbeing, hunger, thirst
Conflicting evidence: dental status, swallowing, cognitive function, depression, residential status, medication intake and/or polypharmacy, constipation, periodontal disease
van der Pols-Vijlbrief [34], 2014
USA, Canada, Netherlands, Sweden, Cuba, France, Japan, Brazil, UK, Israel, Russia,
28 studies N = 49–12,883, mean > 65y
21.3–56.5%,
CD, N/A
PEM (WL over time/ low nutritional intake/ low BW/ poor appetite) Demographic: sex, age, education
Food Intake: reduced appetite, edentulousness, chewing difficulties
Lifestyle: PA, alcohol use, smoking
Social: few friends, living situation, loneliness, death of spouse
Physical functioning: ADLs
Psychological: depression, cognitive decline, dementia, anxiety
Disease-related: hospitalisation, SR health status, polypharmacy, chronic diseases, cancer
N/A MV analyses Association: poor appetite
Moderate evidence for an association: edentulousness, hospitalization, SR health
moderate evidence for no association: older age, low education, depression, chronic diseases
Strong evidence for no association: few friends, living alone, loneliness, death of spouse
No association: chewing difficulties, alcohol consumption, anxiety, number of diseases, heart failure, use of anti-inflammatories
Inconclusive: sex, low PA, smoking, ADL dependency, cognitive decline, dementia, polypharmacy
Meta-analysis
Streicher [33], 2018, 6 studies: Germany (30, Ireland (1), Netherlands (1), New Zealand (1),
N = 209–1841, 71.7 (5.0)- 84.6 (0.5)
36.6–50.5%, CD, N/A MN (BMI < 20 kg/m2 or WL > 10% over FU) Demographic: age, sex, marital status, education
Social: living alone, social support
Lifestyle: PA, smoking status, alcohol consumption
Disease-related: comorbidities (> 2), hospitalisation (6 m/1 y before baseline and 6 m/1 y before FU), pain, SR health, polypharmacy (> 5 drugs)
Psychological: cognitive impairment (MMSE < 23, TICS-m < 31), depression (GDS > 6, CES-D > 16, HADS > 8)
Physical functioning: difficulty walking, difficulty climbing stairs, HGS, falls (y before baseline and 1 y/2 y before FU)
Food intake: appetite
1–3 y LR analyses (UV and MV), random-effects meta-analyses increasing age [1.05 (1.03–1.07) p < 0.05]; unmarried, separated, or divorced status [1.54 (1.14–2.08) p < 0.05]; difficulty walking 100 m [1.41 (1.06–1.89) p < 0.05]; difficulty climbing stairs [1.45 (1.14–1.85) p < 0.05]; hospitalisation before baseline [1.49 (1.25–1.76) p < 0.05]; hospitalisation during FU [2.02 (1.41–2.88) p < 0.05]
  1. A accelerated, AACI Charlson’s Age Adjusted Co-Morbidity Index, ADL activities of daily living, AGGIR Autonomy, Gerontology and Group Resources Scale, ANOVA analysis of variance, ANSI Australian nutritional screening initiative, BI Barthel Index, BMI body mass index, BOHSE Brief Oral Health State Examination, BP blood pressure, BW body weight, CCI Charlson Comorbidity Index, CD community dwelling, CDS chronic disease score, CESD center for epidemiologic studies depression scale, CHD coronary heart disease, CI confidence interval, CIDI Composite International Diagnostic Interview, CNAQ Council on Nutrition Appetite Questionnaire, CPS Cognitive performance scale, CRP C-reactive protein, CVD cardiovascular disease, DM diabetes mellitus, EAT-10 Eating Assessment Tool-10, EI energy intake, ENS elderly nutrition screening, EPI Eysenck Personality Inventory, EQ-5D euro quality of life- 5 dimension, ESDS Enforced Social Dependency Scale, FFMI fat free mass index, FTSTS Five-times-sit-to-stand test, FU follow up, GDS geriatric depression scale, GFI Groningen Frailty Index, GOHAI Geriatric Oral Health Assessment Index, GP general practitioner, HADS Hospital Anxiety and Depression Scale, HDDS Household Dietary Diversity Score, HEI Healthy Eating Index, HFIAS Household Food Insecurity Access Scale, HGS handgrip strength, HR hazards regression, HTAQ Health and Taste Attitudes Questionnaire, HUI Health Utility Index, IADL instrumental activities of daily living, invol involuntary, IM-E-SA INTERMED questionnaire for the Elderly Self-Assessment, IQCODE Informant Questionnaire on Cognitive Decline in the Elderly, IQR interquartile range, LAPAQ Longitudinal Aging Study Amsterdam (LASA)-Physical Activity Questionnaire, lb pound, LR logistic regression, LSNS-6 Lubben social network scale-6, m months, MAG Malnutrition Advisory Group, MCI mild cognitive impairment, MCS mental component score, MEDAS Mediterranean Diet Adherence Screen, MI myocardial infraction, min minute, MMSE mini mental state examination, MN malnutrition, MNA mini nutritional assessment, MNA-SF mini nutritional assessment- short form, MoCA Montreal Cognitive Assessment, MOS Medical Outcomes Study, MOW meals on wheels, MUAC mid-upper arm circumference, MUST malnutrition universal screening tool, MV multivariate, NEADL Nottingham Extended Activities of Daily Living, NHP Nottingham health profile, NIDS National Irish Deprivation Score, NRS-2002 Nutritional Risk Screening, NUFFE Nutritional Form For the Elderly, NUFFE-NO Norwegian version of the Nutritional Form For the Elderly, OARS Older Americans Resources and Services, OHQ oral health questionnaire, OR odds ratio, OSLO 3-SSS Oslo 3 item social support scale, PA physical activity, PASE Physical Activity Scale for the Elderly, PCS physical component score, PEM protein energy malnutrition, PGC MAI Philadelphia Geriatric Centre Multilevel Assessment Instrument, QOL quality of life, RR risk ratio, S successful, SASE Self-care Ability Scale for Elderly, SC senior centre, SCL-10 symptoms check list- 10, SCREEN Seniors in the community: Risk Evaluation for eating and Nutrition, SD standard deviation, SEM structural equation modelling, SF-12 short form survey-12, SF-36 short form survey-36, SHPS Subjective Health Perceptions Scale, SNAQapp Simplified Nutritional Appetite Questionnaire, SNAQ65+ Short Nutritional Assessment Questionnaire for over 65 s, SOC Sense of coherence scale, SOF Study of osteoporotic fractures, SPMSQ Short-Portable Mini-Mental Status Questionnaire, SR self rated, SSQSF Social Support Questionnaire- Short Form, STAI Y-B State-Trait Anxiety Inventory form Y, TICS-m modified Telephone Interview for Cognitive Status, TUG Timed Up and Go, U usual, U-A usual to accelerated, U-S usual to successful, UCLA University of California at Los Angles, UV univariate, VA Veterans Administrative, VAS visual analogue scale, WC waist circumference, WHOQOL world health organisation quality of life scale, WL weight loss, y years, 3MS Modified Mini-Mental State
  2. a answering ‘yes’ to either an ADL/IADL was categorised as ‘need’; b assessed using PGC-MAI: measures cognition, physical health, mobility, ADLs, time use, personal adjustment, social interaction and environmental domains; c dependent for activities of daily living (grocery shopping, transportation, cooking, or self-care); *Key results are only presented for multivariate analyses