Elsevier

Ageing Research Reviews

Volume 63, November 2020, 101137
Ageing Research Reviews

Estimates of malnutrition and risk of malnutrition among the elderly (≥60 years) in India: A systematic review and meta-analysis

https://doi.org/10.1016/j.arr.2020.101137Get rights and content

Highlights

  • The prevalence of malnutrition among elderly in India was 18.29%.

  • The risk of malnutrition is more than double (∼50%) of prevalence of malnutrition.

  • Significant difference was observed between prevalence of malnutrition and gender/study setting/study region.

  • Highest prevalence of malnutrition among elderly is in northern India and highest risk is in central India.

  • The prevalence of malnutrition among elderly can be significantly predicted on the basis of geographical regions.

Abstract

Background

Death is inevitable, but healthy ageing is possible with proper nutrition and health care. This systematic review and meta-analysis conducted to estimate the nation-wide prevalence and malnutrition and risk of malnutrition among the elderly in India.

Methods

PubMed, EMBASE, Web of Science, Cochrane`s library, Google Scholar were searched for the articles reporting the prevalence of malnutrition among the elderly using MNA or MNA-SF tools. The study published between the year 2010–2019 were included. Sensitivity analysis, quality assessment was done using standard methods. The publication biasness was also determined using Doi plot and LFK index. The pooled prevalence was reported with effect size and considering the random effect model and quality effect model. The subgroup analysis was also conducted for gender, study setting, study area and study regions.

Results

The prevalence of malnutrition and risk of malnutrition among the elderly was 18.29% and 48.17% respectively. The prevalence of malnutrition was higher among female (16.67%), clinic setting (28.87%), urban areas (19.29%) and northern region (27.37%) of India. This trend differs with the prevalence of risk of malnutrition. Meta-regression analysis shows a region-based prediction of malnutrition and setting based prediction of risk of malnutrition.

Conclusion

The prevalence of malnutrition was not considerably higher among the elderly population but about half of the elderly population were at risk of malnutrition. This trend differs with the gender, study setting, study area and study region. Additional study using other nutritional assessment tools were needed. Intervention studies among the elderly were recommended.

Section snippets

Background

According to the United Nations, 962 million people were aged 60 or above in the year 2017 with the largest share (549.2 million) living in the Asian regions. The elderly population in India is 9.4% with an estimated increase of up to 19.1% by the year 2050 (United Nations and Department of Economic and Social Affairs, P.D, 2017). Ageing is an invincible process ultimately leading to death. Better health care and advancement in medical sciences have increased the life expectancy of people in

Methods

This systematic review and meta-analysis were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines (Fig. 1) (Moher et al., 2009) and registered at Prospero registry for systematic review (Reg. No. CRD42020169184) (Kushwaha et al., 2020).

Results

In this review data from 45 studies were included and analysed to obtain the pooled prevalence of malnutrition and risk of malnutrition. Fourteen studies were published in the year 2018 and 42 and 3 have used MNA and MNA-SF tool for nutritional status assessment respectively (Table 1). 25 studies have mentioned the malnutrition prevalence separately for male and female and 24 have mentioned the prevalence of risk of malnutrition separately for both the genders. 5 studies were conducted in the

Discussion

This meta-analysis includes 45 studies and estimated prevalence of malnutrition (18.29%) and risk of malnutrition (48.17%) among the elderly in India. The prevalence of malnutrition in the present review was higher than the world-wide meta-analysis result of (Crichton et al., 2019) in South Asia (India & Bangladesh) i.e., 7.8%.This variation might be due to the consideration of different assessment tools and combination of pooled estimates from two countries. The overall international pooled

Strength

This was the first nation-wide estimate of the prevalence of malnutrition and risk of malnutrition among the elderly in India. The consideration of only MNA and MNA-SF nutritional assessment tool could preserve the appropriateness of this review because it is a validated tool for assessing malnutrition in the elderly. The subgroup analysis shows differential prevalence based on gender, study setting, study area and study region. The quality effect model reduces the estimator variance while

Limitations

The pooled prevalence was estimated from studies considering MNA and MNA-SF tools only so, results could be questioned because it may vary when other malnutrition screening tools were considered. The random effect model prevalence estimates can be used with caution. This review includes data only from 15 Indian states and 3 union territories out of 29 Indian states and 9 Union territories.

Conclusion

The pooled prevalence of malnutrition among the elderly was not considerably higher but risk of malnutrition ∼50% was a matter of concern. The prevalence slightly varied when quality effect model was considered over random effect model. These estimates can be used by policymakers and public health workers for controlling malnutrition and intervention development. The elderly of old age homes was at greater risk of malnutrition. The option of providing subsidized or free mid-day meal fortified

Authors` contributions

Designing the review: PK and TK, Data search and extraction: SK and RJ, Data analysis: TK, SK and RS, Data interpretation: TS, TK and SK. Wrote the paper: RS, RJ and PK, Critical evaluation of manuscript: TS and PK.

Funding source

None.

Ethical approval

Not required.

Declaration of Competing Interest

Authors declare no competing interest.

Acknowledgements

Not applicable

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