A systematic review and meta-analysis of prevalence of protein-energy malnutrition in the international community: A look at the influence of region, rurality, setting and gender (the macro study)

Protein-energy malnutrition is a major health concern in homedwelling older adults, particularly in the context of population ageing. Therefore, a systematic review and meta-analysis was undertaken to examine the international prevalence of malnutrition in older adults living independently in the community; including examination of geographical region, rurality and gender. Six electronic databases weresearched until September 2016. Original research studies which used the Mini Nutritional Assessment (MNA), patient generated – subjective global assessment (PG-SGA) or SGA to determine nutrition status in community samples with a mean age of ≥ 65 years were included and critically appraised and pooled using meta-analysis. 112 studies from 38 countries (n = 69,498 total participants) were included. The global prevalence of malnutrition in the older community setting was 6.9% (95% CI: 5.6–8.3%), ranging from 0.8% (95% CI: 0.2–1.7%) in Northern Europe to 29.9% (95% CI: 0.0–80.3%) in South-East Asia. Of all settings, participants receiving homecare services had the highest prevalence at 13.2% (95% CI: 9.0–18.2). Malnutrition prevalence in rural communities (9.9%; 95% CI: 4.5–16.8%) was double that in urban communities (5.1%; 95% CI: 3.7–6.7%) and significantly higher among females than males (OR 1.50 [95% CI: 1.27–1.75]; P < 0.00001). The results of this review provide the best available strategic insight for global and national public health priorities for preventing malnutrition and associated poor health outcomes.