A systematic review, meta-analysis and meta-regression of the prevalence of protein-energy malnutrition: associations with geographical region and sex

Age Ageing. 2019 Jan 1;48(1):38-48. doi: 10.1093/ageing/afy144.


Background: protein-energy malnutrition is a major health concern in home-dwelling older adults, particularly in the context of an ageing population. Therefore, a systematic review and meta-analysis was undertaken to determine the prevalence of malnutrition among older adults living independently in the community according to geographical region, sampling frame, rurality and sex.

Methods: six electronic databases were searched until September 2016. Original research studies which used the Mini Nutritional Assessment, Patient-Generated Subjective Global Assessment or Subjective Global Assessment to determine nutrition status in community samples with a mean age of ≥65 years were critically appraised and pooled using meta-analysis. Meta-regression was used to explore predictors of malnutrition prevalence in pooled statistics with high heterogeneity.

Results: 111 studies from 38 countries (n = 69,702 participants) were included. The pooled prevalence of malnutrition in the older community setting ranged from 0.8% (95% CI: 0.2-1.7%) in Northern Europe to 24.6% (95% CI: 0.0-67.9%) in South-East Asia. Of all sampling frames, participants receiving homecare services had the highest prevalence at 14.6% (95% CI: 9.9-20.0%). Malnutrition prevalence in rural communities (9.9%; 95% CI: 4.5-16.8%) was double that in urban communities (5.7%; 95% CI: 4.2-7.3%) and higher among females than males (odds ratio = 1.45 [95% CI: 1.27-1.66]; P < 0.00001).

Conclusions: the results of this review provide strategic insight to develop public and community health priorities for preventing malnutrition and associated poor health outcomes.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Age Factors
  • Aged
  • Female
  • Geography, Medical
  • Humans
  • Male
  • Prevalence
  • Protein-Energy Malnutrition / epidemiology*
  • Protein-Energy Malnutrition / etiology
  • Risk Factors
  • Sex Factors