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