Prevalence of malnutrition in a non-institutionalized elderly population of Benilloba, Alicante

Abstract

The objective of this study is to determine the prevalence of malnutrition in a non- institutionalized elderly population of Benilloba, Alicante (Spain), by evaluating their nutritional status. Thirty-seven older adults participated in the study(57% women and 43% men) with a mean age of 80.7 ± 6.1 years, representing 14.8% of the total older population (n = 250) of Benilloba. Anthropometric and lifestyle parameters were measured using the Mini Nutritional Assessment (MNA) as the main tool. It was observed that 57% had an adequate nutritional status compared to 43% presented nutritional risk or malnutrition; this situation got worse in people older than 84 years and women. The main negative items registered in the evaluation were: acute disease or stress, to take >3 medicines per day and low liquid intake.

INTRODUCTION

Over the last century, life expectancy and quality of life in Western countries have increased significantly, largely attributable to scientific advances, developments in medicine and public health, and improvements in socioeconomic conditions (1).

In Spain, life expectancy has shown a sustained increase over the years, reaching an average of 83.77 years in 2024. This value is higher among women, with 86.34 years, compared with men, whose average stands at 81.11 years (2). Consequently, Spain has consolidated its position as one of the countries with the highest life expectancy within the Organisation for Economic Co-operation and Development.

This demographic evolution is similar to that observed in other European countries over recent decades, although its impact is particularly pronounced in Southern Europe, where population aging has become a phenomenon of special relevance. Changes in population age structure have significant effects across multiple domains—social, economic, healthcare, and political—requiring Spanish society to address the challenge of managing this process efficiently in order to ensure that older adults can experience this stage of life in optimal physical and mental conditions (3).

Currently, it is estimated that approximately 9.5 million people aged ≥65 years live in Spain, a figure expected to continue increasing over the coming decades (4). The World Health Organization identifies older adults as a nutritionally vulnerable population group and considers nutritional status a key indicator of quality of life in this stage of life (5).

The World Health Organization defines malnutrition as a disorder resulting from an imbalance between energy and nutrient intake and the body’s nutritional requirements, capable of causing alterations in health, development, and functional capacity. It represents a public health problem with important clinical consequences, including increased morbidity, longer hospital stays, and higher healthcare costs. In Spain, its prevalence varies depending on the population group and the methods used for nutritional screening and assessment. The highest percentages are observed among long-term hospitalized patients (56%) and institutionalized older adults (28.4%). Even among older adults living in the community, a considerable proportion of cases has been reported, estimated at approximately 7.8%, highlighting the need for preventive strategies and early detection (6).

Malnutrition in the older population has a complex and multifactorial etiology, involving physiological, social, and clinical factors. Physiological factors include alterations in the digestive system, such as tooth loss, xerostomia, dysphagia, and disorders related to digestion or nutrient absorption. These are compounded by socioeconomic conditions, mental disorders, chronic diseases, and situations that compromise mobility or autonomy, such as polypharmacy, prolonged hospitalization, or bedridden status. All these circumstances contribute to deterioration in overall health and weakening of the immune system, increasing the risk of infections, delaying wound healing, and promoting complications of cardiovascular, respiratory, digestive, metabolic, and endocrine origin (7).

Through individualized nutritional interventions, many of these health problems could be significantly prevented, thereby improving patients’ quality of life (8). It is essential that interventions are personalized and based on an assessment of each individual’s nutritional status, with periodic reviews to adjust the implemented measures. In this context, implementing an early diagnostic protocol using the Mini Nutritional Assessment questionnaire is particularly useful for identifying the prevalence of malnutrition and establishing nutritional strategies aimed at reversing this condition (9).

The Mini Nutritional Assessment is a validated instrument designed to assess nutritional status and quickly and accurately identify the risk of malnutrition. It consists of two sections: a screening phase that considers parameters such as body mass index (BMI), recent weight loss, and food intake; and an assessment phase that evaluates aspects related to functional autonomy, the presence of diseases, and usual medication use. Based on the results obtained, individuals are classified into three categories: adequate nutritional status, risk of malnutrition, or established malnutrition. Due to its ease of use and high sensitivity, the MNA is considered the reference tool for the early detection and nutritional management of older adults (10).

OBJECTIVE

Primary Objective

To determine the prevalence of malnutrition in the older population of Benillob.

Secondary Objective

• To determine the health status of the population.

• To determine whether there are significant differences in nutritional status between men and women.

• To determine whether nutritional status is associated with the age range of older adults.

SAMPLE

The study included older adults (≥65 years) of both sexes, non-institutionalized, and residing in the town of Benilloba.

Individuals with cognitive impairment that prevented completion of the test, as well as bedridden older adults or those with severe mobility limitations, were excluded.

A total of 37 older adults (≥65 years) voluntarily participated in the study, with a mean age of 80.7 ± 6.1 years; 57% were women and 43% were men. The analyzed sample (n = 37) represents 14.8% of the older population of Benilloba, which consists of 250 individuals aged 65 years or older (11).

The sample was stratified by sex and age, dividing participants into three age groups: 65–74 years, 75–84 years, and ≥85 years.

METHODOLOGY

Nutritional status was assessed using the Mini Nutritional Assessment questionnaire (12). This test shows excellent diagnostic validity, with high sensitivity (96%) and specificity (98%) (10), and allows the detection of malnutrition risk before clinical alterations appear.

The questionnaire was administered by community pharmacy staff in Benilloba during May, June, and July 2024. The personnel received prior training on the questionnaire before data collection.

The Mini Nutritional Assessment consists of 18 items grouped into four sections: Anthropometry, Global Assessment, Dietary Parameters, and Subjective Assessment. The maximum score is 30 points; scores ≥24 indicate optimal nutritional status, scores between 17.0 and 23.5 indicate risk of malnutrition, and scores <17 indicate malnutrition.

Block 1. Anthropometric parameters: Four parameters with easy measurement and reproducibility were analyzed. The first was body mass index (BMI), calculated from weight and height and expressed in kg/m². The second was mid-upper arm circumference (MUAC), measured at the midpoint between the acromion and olecranon. The third parameter was calf circumference (CC), measured at the widest point between the ankle and knee. The fourth parameter assessed was weight loss during the previous three months.

Block 2. Global assessment: This section evaluated whether the patient lived independently, took more than three medications per day, experienced psychological stress, degree of mobility, presence of neuropsychological problems, and the presence of pressure ulcers or skin lesions.

Block 3. Dietary parameters: This section assessed the number of full meals consumed daily, protein intake, consumption of fruits and vegetables, fluid intake, reduction in food intake due to digestive disorders, and autonomy in feeding.

Block 4. Subjective assessment: The final section evaluated the patient’s self-perception of their health status and how they perceived their health compared with others of the same age.

Anthropometric measurements were taken at the community pharmacy by pharmacy staff. The following parameters were measured: weight (kg) using a SECA digital scale (precision 0.1 kg) with light clothing and no shoes; mid-upper arm circumference (cm) using a non-elastic measuring tape (precision 0.1 cm) at the midpoint between the acromion and olecranon of the non-dominant arm; and calf circumference (cm) at the widest point. Measurements were taken in triplicate, and the mean value was recorded. BMI (kg/m²) was calculated from weight (kg) and height (m).

Statistical analysis was performed using Microsoft Excel for Windows. A descriptive analysis (means and frequencies) was conducted, comparing results by sex, age groups, and the four assessment domains.

RESULTS AND FOLLOW-UP

The mean body mass index (BMI) of the sample (Table 1) was 25.7 ± 2.5 kg/m². In men, weight, height, and BMI values were higher than those observed in women. Regarding nutritional status assessed using the Mini Nutritional Assessment questionnaire, 52% of the sample presented an optimal nutritional status, 38% were at risk of malnutrition, and 5% were classified as malnourished.

When analyzing results by sex (Table 1), 25% of men were at risk of malnutrition, and 62.5% had an optimal nutritional status. Among women, 48% were at risk of malnutrition, while the remaining 52% presented an optimal nutritional status. In contrast, a higher proportion of malnutrition was observed among men compared with women (12.5% vs. 0%).

The mean score obtained with the Mini Nutritional Assessment was 24.4 ± 4.6 (Table 2), indicating an overall normal nutritional status for the sample (24–30 points). When stratified by sex, both groups showed, on average, an optimal nutritional status, with slightly higher values among men (24.5 points for men and 24.3 points for women).

Analysis by age groups (Table 3) showed that individuals aged ≥85 years had the poorest nutritional status, with 14% malnourished, 43% at risk of malnutrition, and only 43% presenting optimal nutritional status. The 75–84-year-old group showed the best nutritional status, with 67% presenting optimal nutritional status and 33% at risk of malnutrition. Finally, the youngest group (65–74 years) showed 60% with optimal nutritional status and 40% at risk of malnutrition.

Analysis of the four domains of the Mini Nutritional Assessment and their contribution to nutritional status (Table 4) showed that the dietary parameters domain obtained the highest score, with a mean of 7.8 points out of 9 (ratio 0.87), followed by anthropometric parameters, with 6.7 points out of 8 (ratio 0.84). The domain contributing the least to nutritional status was the subjective assessment, which obtained 2.9 points out of 4 (ratio 0.73).

Regarding anthropometric parameters, 81% of participants had a BMI greater than 23 kg/m², and most presented high ranges of arm and calf circumference. In the global assessment domain, the population was not excessively exposed to polypharmacy, as only 30% took more than three medications per day. Additionally, most participants lived independently (76%), left their homes regularly (84%), and did not present neuropsychological problems (84%). Concerning dietary parameters, 86% reported consuming three complete meals per day, 76% frequently consumed protein, and almost all participants (97%) consumed fruit and vegetables twice daily. Finally, within the subjective assessment domain, the factor that most influenced the lower score was the perception of personal health compared with other older adults of the same age, as only 38% considered their health to be better than that of their peers.

Table 1.

Description of the sample.

Variable	Sample	Men	Women
Nº Individuals (%)	37 (100%)	16 (43%)	21 (57%)
Age (years)	80.7±6.1	81.5±7.4	80.1±5.0
>85 years	38%	57%	43%
75-84 years	49%	28%	72%
65-74 years	14%	60%	40%
Weight (kg)	69.6±8.2	70.8±6.7	62.3±7.4
Height (m)	1.65±0.05	1.66±0.04	1.59±0.04
BMI (Kg/m2)	25.7±2.5	25.7±2.3	24.5±2.5
Malnutrition (%)	5%	12.5%	0%
Malnutrition Risk (%)	38%	25%	48%
Optimal nutritional status (%)	57%	62.5%	52%

Table 2.

Mean ± standard deviation of the results of the MNA and its four domains.

Variable	Sample	Men	Women
TOTAL MNA	24.2±4.6	24.5±5.8	24.3±4.1
Anthropometry	6.7±1.6	6.7±1.5	6.6±1.7
Overall Assessment	6.8±2.0	6.8±2.3	6.9±1.9
Dietary parameters	7.8±1.2	7.6±1.6	8.0±0.9
Subjective Assessment	2.9±1.1	2.9±1.2	2.9±1.1

Table 3.

Nutritional status of the population by age groups and scores for the MNA and its four domains.

Age groups	Normal	Risk	Malnut.	MNA	A	OA	DP	SA
≥85	43%	43%	14%	25.2±3.3	7.4±1.3	6.4±1.7	8.2±0.8	3.2±1.1
75-84	67%	33%	0%	25.3±3.8	6.7±1.7	7.4±1.7	8.1±0.7	3.0±1.0
65-74	60%	40%	0%	22.5±5.7	6.3±1.6	6.2±2.4	7.3±1.6	2.6±1.3

A (anthropometric parameters); OA (overall assessment); DP (dietary parameters); SA (subjective assessment)

Table 4.

Mean values (mean ± SD) for the four MNA domains and percentage of the population for each response.

MNA (Mini Nutritional Assessment)
ANTHROPOMETRIC PARAMETERS (6,7±1,6)
1. Body Mass Index (BMI)
IMC<19 : 3%	IMC 19-21 : 0%	IMC 21-23 : 16%	IMC>23 : 81%
2. Arm Circumference (AC)
CB<21 : 3%	21≤ CB ≤ 22 : 35%	CB >22 : 62%
3. Calf Circumference (CC)
CP < 31 : 27%	CP ≥ 31 : 73%
4. Weight loss over the last 3 months
>3 kg : 5%	Does not know : 3%	Between : 35%	No lost weight : 57%
OVERALL ASSESSMENT (6,8±2,0)
5. Live independently
Yes : 76%	No : 24%
6. Takes more than 3 medicines a day
Yes : 30%	No : 70%
7. Experienced psychological stress or recent illness
Yes : 41%	No : 59%
8. Mobility
Bed or chair bound : 3%	Interior mobility : 14%	Goes out : 84%
9. Neuropsychological problems
Severe dementia or depression : 5%	Mild dementia: 11%	No psychological problems : 84%
10. Pressure ulcers or skin lesions
Yes : 0%	No : 100%
DIETARY PARAMETERS (7,8±1,2)
11. Full daily meals
1: 0%	2: 14%	3: 86%
12. Consumes one dairy product daily; consumes legumes or eggs 1–2 times per week; consumes fish or poultry daily
0% = 0 or 1 “yes” responses	224% = 2 “yes” responses	76% = 3 “yes” responses
13. Consumption of fruits and vegetables twice per day
Yes: 97%	No: 3%
14. Reduced food intake during the last 3 months due to loss of appetite, digestive problems, or difficulties chewing or swallowing
Consumes much less: 0	Consumes less: 38%	Consumes the same: 62%
15. Daily fluid intake
<3 glasses: 3%	3–5 glasses: 76%	>5 glasses: 22%
16. Feeding mode
With assistance: 3%	Self-feeding, with difficulty: 5%	Self-feeding, without difficulty: 92%
SUBJECTIVE ASSESSMENT (2,6±1,3)
17. Self-perception of nutritional problems
Severe malnutrition: 0%	Does not know or moderate malnutrition: 30%		No nutritional problems: 70%
18. Health status compared with others of the same age
Worse: 16%	Does not know: 14%	Same: 32%	Better: 38%