There were 111 included studies (Figure 1), which reported data on 114 samples (Appendix 2, available in Age and Ageing online). The majority of prevalence data was reported by cross-sectional studies (n = 89), followed by prospective observational studies (n = 13), baseline data from intervention studies (n = 7) then retrospective studies (n = 2). The method used by included studies to report the age of participants varied greatly between studies, preventing a summary of age ranges (Appendix 2, available in Age and Ageing online). Samples from 38 countries were included, with the majority from Europe (n = 51 samples) and Asia (n = 38 samples). There were 12 samples from North America and seven from Oceania (all from Australia), with only four samples from South America and two from Africa. These studies had a total participant sample size of 69,702, nearly half of which were participants from Spain (n = 30,190 participants). Participants from studies conducted in China comprised the second largest group by country (n = 8,871 participants) followed by Turkey (n = 5,487 participants) (Table 1).
The pooled prevalence of protein-energy malnutrition in community-dwelling older adults by country and/or geographical region, presented from lowest to highest prevalence.
| Geographical region . | Countries included in meta-analysis . | Number of studies . | Sample size . | Qualitya . | Prevalence of malnutritionb (% [95% CI]) . | Heterogeneity (I2, %) . | Prevalence of malnutritionb with sensitivity analysis (% [95% CI]) . | Heterogeneity with sensitivity analysis (I2, %) . | Sensitivity analysis: reason for removed studies . |
|---|---|---|---|---|---|---|---|---|---|
| Northern Europe | Netherlands, Sweden | 17 | 2,267 | 5/3/0 | 2.5 [0.1–7.1] | 95.9 | 0.8 [0.2–1.7] | 50.2 | Age > 80 yearsd |
| East Asia | China | 10 | 8,871 | 2/7/0d | 2.4 [1.5–3.5] | 83.3 | 1.6 [0.8–2.6] | 61.9 | Setting other than ‘community’ |
| South America | Brazil, Chile | 31 | 2,005 | 2/2/0 | 1.7 [0.9–2.8] | 52.0 | – | – | – |
| European Russia | Russia | 1 (not pooled)c | 611 | 1/0/0 | 1.8 | – | – | – | – |
| Northern Europe | Denmark, Finland | 13 | 691 | 0/4/0 | 1.9 [0.6–3.8] | 37.6 | – | – | – |
| Central Europe | Poland | 4 | 2,098 | 2/2/0 | 2.7 [0.1–7.9] | 95.5 | – | – | – |
| Western Europe | Ireland, United Kingdom | 31 | 847 | 1/3/0 | 2.8 [0.0–7.3] | 86.5 | – | – | – |
| Middle East | Turkey | 6 | 5,487 | 4/2/0 | 5.1 [1.6–10.1] | 97.6 | 3.0 [2.2–3.9] | 0.0 | Setting other than ‘community’ |
| Central Europe | Germany | 4 | 705 | 1/3/0 | 4.3 [0.0–14.1] | 95.8 | – | – | – |
| Southwestern Europe | Spain | 19 | 30,190 | 7/12/0 | 4.8 [3.2–6.7] | 95.0 | – | – | – |
| Australia/New Zealand | Australia | 7 | 871 | 3/4/0 | 18.1 [4.3–37.5] | 97.1 | 6.0 [4.4–8.2] | 14.7 | Assessment tools SGA and PG-SGA |
| Middle East | Israel, Lebanon | 13 | 2,762 | 2/2/0 | 6.1 [3.3–9.7] | 90.8 | – | – | – |
| East Asia | Japan, South Korea | 41 | 905 | 2/2/0 | 6.4 [0.7–16.1] | 95.0 | – | – | – |
| North America | Canada, United States of America | 15 | 683 | 3/3/0 | 6 [1.4–17.5] | 92.3 | – | – | – |
| South Asia | India, Bangladesh | 31 | 1,126 | 2/2/0 | 7.8 [0.1–17.7] | 92.1 | – | – | – |
| Middle East | Iran | 6 | 4,507 | 2/4/0 | 7.3 [4.7–10.5] | 90.9 | – | – | – |
| Southern Europe | Italy, France | 22 | 1,061 | 1/3/0 | 11.0 [0.0–50.2] | 99.5 | – | – | – |
| Central America/Caribbean | Cuba, Mexico | 15 | 1,317 | 3/3/0 | 12.6 [2.5–27.6] | 96.8 | – | – | – |
| Central and West Africa | Democratic Republic of the Congo, Nigeria | 11 | 870 | 1/1/0 | 14.5 [0.0–40.4] | 98.5 | – | – | – |
| Central Europe | Czech Republic, Austria | 21 | 673 | 1/2/0 | 16.5 [4.1–33.8] | 94.5 | – | – | – |
| Southeast Asia | Laos Singapore, Thailand | 111 | 1,155 | 2/1/0 | 24.6 [0.0–67.9] | 99.5 | – | – | – |
| Geographical region . | Countries included in meta-analysis . | Number of studies . | Sample size . | Qualitya . | Prevalence of malnutritionb (% [95% CI]) . | Heterogeneity (I2, %) . | Prevalence of malnutritionb with sensitivity analysis (% [95% CI]) . | Heterogeneity with sensitivity analysis (I2, %) . | Sensitivity analysis: reason for removed studies . |
|---|---|---|---|---|---|---|---|---|---|
| Northern Europe | Netherlands, Sweden | 17 | 2,267 | 5/3/0 | 2.5 [0.1–7.1] | 95.9 | 0.8 [0.2–1.7] | 50.2 | Age > 80 yearsd |
| East Asia | China | 10 | 8,871 | 2/7/0d | 2.4 [1.5–3.5] | 83.3 | 1.6 [0.8–2.6] | 61.9 | Setting other than ‘community’ |
| South America | Brazil, Chile | 31 | 2,005 | 2/2/0 | 1.7 [0.9–2.8] | 52.0 | – | – | – |
| European Russia | Russia | 1 (not pooled)c | 611 | 1/0/0 | 1.8 | – | – | – | – |
| Northern Europe | Denmark, Finland | 13 | 691 | 0/4/0 | 1.9 [0.6–3.8] | 37.6 | – | – | – |
| Central Europe | Poland | 4 | 2,098 | 2/2/0 | 2.7 [0.1–7.9] | 95.5 | – | – | – |
| Western Europe | Ireland, United Kingdom | 31 | 847 | 1/3/0 | 2.8 [0.0–7.3] | 86.5 | – | – | – |
| Middle East | Turkey | 6 | 5,487 | 4/2/0 | 5.1 [1.6–10.1] | 97.6 | 3.0 [2.2–3.9] | 0.0 | Setting other than ‘community’ |
| Central Europe | Germany | 4 | 705 | 1/3/0 | 4.3 [0.0–14.1] | 95.8 | – | – | – |
| Southwestern Europe | Spain | 19 | 30,190 | 7/12/0 | 4.8 [3.2–6.7] | 95.0 | – | – | – |
| Australia/New Zealand | Australia | 7 | 871 | 3/4/0 | 18.1 [4.3–37.5] | 97.1 | 6.0 [4.4–8.2] | 14.7 | Assessment tools SGA and PG-SGA |
| Middle East | Israel, Lebanon | 13 | 2,762 | 2/2/0 | 6.1 [3.3–9.7] | 90.8 | – | – | – |
| East Asia | Japan, South Korea | 41 | 905 | 2/2/0 | 6.4 [0.7–16.1] | 95.0 | – | – | – |
| North America | Canada, United States of America | 15 | 683 | 3/3/0 | 6 [1.4–17.5] | 92.3 | – | – | – |
| South Asia | India, Bangladesh | 31 | 1,126 | 2/2/0 | 7.8 [0.1–17.7] | 92.1 | – | – | – |
| Middle East | Iran | 6 | 4,507 | 2/4/0 | 7.3 [4.7–10.5] | 90.9 | – | – | – |
| Southern Europe | Italy, France | 22 | 1,061 | 1/3/0 | 11.0 [0.0–50.2] | 99.5 | – | – | – |
| Central America/Caribbean | Cuba, Mexico | 15 | 1,317 | 3/3/0 | 12.6 [2.5–27.6] | 96.8 | – | – | – |
| Central and West Africa | Democratic Republic of the Congo, Nigeria | 11 | 870 | 1/1/0 | 14.5 [0.0–40.4] | 98.5 | – | – | – |
| Central Europe | Czech Republic, Austria | 21 | 673 | 1/2/0 | 16.5 [4.1–33.8] | 94.5 | – | – | – |
| Southeast Asia | Laos Singapore, Thailand | 111 | 1,155 | 2/1/0 | 24.6 [0.0–67.9] | 99.5 | – | – | – |
aAcademy of Nutrition and Dietetics Quality Criteria Checklist rating (number of positive/neutral/negative).
bDetermined by MNA score < 17 or Patient-Generated Subjective Global Assessment or Subjective Global Assessment rating of B and C.
cData not pooled as there were no other samples with reasonable geographical and economical similarities.
dMajority of studies included in this meta-analysis had a younger cohort (65–75 years), therefore the few studies with older cohorts were excluded age was found to be a source of heterogeneity.
eChan et al. [22], which was conducted in China, could not be sufficiently translated to allow for assessment of study quality.
The pooled prevalence of protein-energy malnutrition in community-dwelling older adults by country and/or geographical region, presented from lowest to highest prevalence.
| Geographical region . | Countries included in meta-analysis . | Number of studies . | Sample size . | Qualitya . | Prevalence of malnutritionb (% [95% CI]) . | Heterogeneity (I2, %) . | Prevalence of malnutritionb with sensitivity analysis (% [95% CI]) . | Heterogeneity with sensitivity analysis (I2, %) . | Sensitivity analysis: reason for removed studies . |
|---|---|---|---|---|---|---|---|---|---|
| Northern Europe | Netherlands, Sweden | 17 | 2,267 | 5/3/0 | 2.5 [0.1–7.1] | 95.9 | 0.8 [0.2–1.7] | 50.2 | Age > 80 yearsd |
| East Asia | China | 10 | 8,871 | 2/7/0d | 2.4 [1.5–3.5] | 83.3 | 1.6 [0.8–2.6] | 61.9 | Setting other than ‘community’ |
| South America | Brazil, Chile | 31 | 2,005 | 2/2/0 | 1.7 [0.9–2.8] | 52.0 | – | – | – |
| European Russia | Russia | 1 (not pooled)c | 611 | 1/0/0 | 1.8 | – | – | – | – |
| Northern Europe | Denmark, Finland | 13 | 691 | 0/4/0 | 1.9 [0.6–3.8] | 37.6 | – | – | – |
| Central Europe | Poland | 4 | 2,098 | 2/2/0 | 2.7 [0.1–7.9] | 95.5 | – | – | – |
| Western Europe | Ireland, United Kingdom | 31 | 847 | 1/3/0 | 2.8 [0.0–7.3] | 86.5 | – | – | – |
| Middle East | Turkey | 6 | 5,487 | 4/2/0 | 5.1 [1.6–10.1] | 97.6 | 3.0 [2.2–3.9] | 0.0 | Setting other than ‘community’ |
| Central Europe | Germany | 4 | 705 | 1/3/0 | 4.3 [0.0–14.1] | 95.8 | – | – | – |
| Southwestern Europe | Spain | 19 | 30,190 | 7/12/0 | 4.8 [3.2–6.7] | 95.0 | – | – | – |
| Australia/New Zealand | Australia | 7 | 871 | 3/4/0 | 18.1 [4.3–37.5] | 97.1 | 6.0 [4.4–8.2] | 14.7 | Assessment tools SGA and PG-SGA |
| Middle East | Israel, Lebanon | 13 | 2,762 | 2/2/0 | 6.1 [3.3–9.7] | 90.8 | – | – | – |
| East Asia | Japan, South Korea | 41 | 905 | 2/2/0 | 6.4 [0.7–16.1] | 95.0 | – | – | – |
| North America | Canada, United States of America | 15 | 683 | 3/3/0 | 6 [1.4–17.5] | 92.3 | – | – | – |
| South Asia | India, Bangladesh | 31 | 1,126 | 2/2/0 | 7.8 [0.1–17.7] | 92.1 | – | – | – |
| Middle East | Iran | 6 | 4,507 | 2/4/0 | 7.3 [4.7–10.5] | 90.9 | – | – | – |
| Southern Europe | Italy, France | 22 | 1,061 | 1/3/0 | 11.0 [0.0–50.2] | 99.5 | – | – | – |
| Central America/Caribbean | Cuba, Mexico | 15 | 1,317 | 3/3/0 | 12.6 [2.5–27.6] | 96.8 | – | – | – |
| Central and West Africa | Democratic Republic of the Congo, Nigeria | 11 | 870 | 1/1/0 | 14.5 [0.0–40.4] | 98.5 | – | – | – |
| Central Europe | Czech Republic, Austria | 21 | 673 | 1/2/0 | 16.5 [4.1–33.8] | 94.5 | – | – | – |
| Southeast Asia | Laos Singapore, Thailand | 111 | 1,155 | 2/1/0 | 24.6 [0.0–67.9] | 99.5 | – | – | – |
| Geographical region . | Countries included in meta-analysis . | Number of studies . | Sample size . | Qualitya . | Prevalence of malnutritionb (% [95% CI]) . | Heterogeneity (I2, %) . | Prevalence of malnutritionb with sensitivity analysis (% [95% CI]) . | Heterogeneity with sensitivity analysis (I2, %) . | Sensitivity analysis: reason for removed studies . |
|---|---|---|---|---|---|---|---|---|---|
| Northern Europe | Netherlands, Sweden | 17 | 2,267 | 5/3/0 | 2.5 [0.1–7.1] | 95.9 | 0.8 [0.2–1.7] | 50.2 | Age > 80 yearsd |
| East Asia | China | 10 | 8,871 | 2/7/0d | 2.4 [1.5–3.5] | 83.3 | 1.6 [0.8–2.6] | 61.9 | Setting other than ‘community’ |
| South America | Brazil, Chile | 31 | 2,005 | 2/2/0 | 1.7 [0.9–2.8] | 52.0 | – | – | – |
| European Russia | Russia | 1 (not pooled)c | 611 | 1/0/0 | 1.8 | – | – | – | – |
| Northern Europe | Denmark, Finland | 13 | 691 | 0/4/0 | 1.9 [0.6–3.8] | 37.6 | – | – | – |
| Central Europe | Poland | 4 | 2,098 | 2/2/0 | 2.7 [0.1–7.9] | 95.5 | – | – | – |
| Western Europe | Ireland, United Kingdom | 31 | 847 | 1/3/0 | 2.8 [0.0–7.3] | 86.5 | – | – | – |
| Middle East | Turkey | 6 | 5,487 | 4/2/0 | 5.1 [1.6–10.1] | 97.6 | 3.0 [2.2–3.9] | 0.0 | Setting other than ‘community’ |
| Central Europe | Germany | 4 | 705 | 1/3/0 | 4.3 [0.0–14.1] | 95.8 | – | – | – |
| Southwestern Europe | Spain | 19 | 30,190 | 7/12/0 | 4.8 [3.2–6.7] | 95.0 | – | – | – |
| Australia/New Zealand | Australia | 7 | 871 | 3/4/0 | 18.1 [4.3–37.5] | 97.1 | 6.0 [4.4–8.2] | 14.7 | Assessment tools SGA and PG-SGA |
| Middle East | Israel, Lebanon | 13 | 2,762 | 2/2/0 | 6.1 [3.3–9.7] | 90.8 | – | – | – |
| East Asia | Japan, South Korea | 41 | 905 | 2/2/0 | 6.4 [0.7–16.1] | 95.0 | – | – | – |
| North America | Canada, United States of America | 15 | 683 | 3/3/0 | 6 [1.4–17.5] | 92.3 | – | – | – |
| South Asia | India, Bangladesh | 31 | 1,126 | 2/2/0 | 7.8 [0.1–17.7] | 92.1 | – | – | – |
| Middle East | Iran | 6 | 4,507 | 2/4/0 | 7.3 [4.7–10.5] | 90.9 | – | – | – |
| Southern Europe | Italy, France | 22 | 1,061 | 1/3/0 | 11.0 [0.0–50.2] | 99.5 | – | – | – |
| Central America/Caribbean | Cuba, Mexico | 15 | 1,317 | 3/3/0 | 12.6 [2.5–27.6] | 96.8 | – | – | – |
| Central and West Africa | Democratic Republic of the Congo, Nigeria | 11 | 870 | 1/1/0 | 14.5 [0.0–40.4] | 98.5 | – | – | – |
| Central Europe | Czech Republic, Austria | 21 | 673 | 1/2/0 | 16.5 [4.1–33.8] | 94.5 | – | – | – |
| Southeast Asia | Laos Singapore, Thailand | 111 | 1,155 | 2/1/0 | 24.6 [0.0–67.9] | 99.5 | – | – | – |
aAcademy of Nutrition and Dietetics Quality Criteria Checklist rating (number of positive/neutral/negative).
bDetermined by MNA score < 17 or Patient-Generated Subjective Global Assessment or Subjective Global Assessment rating of B and C.
cData not pooled as there were no other samples with reasonable geographical and economical similarities.
dMajority of studies included in this meta-analysis had a younger cohort (65–75 years), therefore the few studies with older cohorts were excluded age was found to be a source of heterogeneity.
eChan et al. [22], which was conducted in China, could not be sufficiently translated to allow for assessment of study quality.
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