TABLE 1.
Longitudinal studies on risk factors for malnutrition in older adults1
| Author, year (reference) | Potential risk factors | Population | Assessment method | Results |
| Shatenstein et al., 2001 (27) | Age | Baseline: 1529 community and 1174 institutionalized subjects | Percentage of initial body weight retained: | Multiple regression: for % of initial body weight2 |
| Cognitive function | Follow-up: 584 community and 237 institutionalized subjects | Prevalence analyses: | Institutionalized subjects: | |
| Study region | >95%, no risk of malnutrition | Frailty, β: −1.23; P = 0.039 | ||
| Ability to eat independently | 85–95%, low risk of malnutrition | Residence in Ontario, β: −9.02; P = 0.000 | ||
| Depression | <85%, moderate/severe risk of malnutrition | Residence in British Columbia, β: −5.62; P = 0.026 | ||
| Self-reported interest in life | Regression analyses: | Residence in Atlantic, β: −3.41; P = 0.225 | ||
| Loss of appetite | >95%, no risk of malnutrition | Residence in prairies, β: −4.54; P = 0.087 | ||
| Weight loss | ≤95%, risk of malnutrition | Community subjects: | ||
| Frailty | Ability to eat unaided, β: 4.24; P = 0.000 | |||
| For community subjects: | Reported sustained interest in life, β: 2.22; P = 0.013 | |||
| Ability to shop | Logistic regression: for malnutrition | |||
| Bereavement | Institutionalized subjects: | |||
| Frailty, β: 0.22; 95% CI: 1.01, 1.54; P = 0.036 | ||||
| Loss of interest in life, β: −0.63; 95% CI: 0.30, 0.93; P = 0.027 | ||||
| Community subjects: | ||||
| Loss of appetite, β: −1.52; 95% CI: 0.12, 0.42; P = 0.000 | ||||
| Loss of interest in life, β: −0.58; 95% CI: 0.34, 0.90; P = 0.017 | ||||
| Mamhidir et al., 2006 (28) | Underweight | Baseline: 719 institutionalized subjects | BMI < 22 and loss of 5% of body weight after 1 mo and 10% after 6 mo | Multiple logistic regression: for malnutrition |
| Weight loss | Follow-up: 503 institutionalized subjects | Dementia, OR: 2.139; 95% CI: 1.343, 3.407; P = 0.001 | ||
| Cognitive function | Parkinson disease, OR: 2.450; 95% CI: 1.006, 5.965; P = 0.047 | |||
| Depression | Eating dependencies, OR: 2.257; 95% CI: 1.676, 3.038; P = 0.001 | |||
| Functional impairment | Constipation, OR: 2.490; 95% CI: 1.185, 4.964; P = 0.015 | |||
| Age | Daily dental hygiene was associated with better weight status (values not given) | |||
| Sex | Logistic regression: predictive factors for malnutrition | |||
| Medical factors: vision problems, eating dependencies, constipation, heart failure, hip fracture, stroke, dementia, Parkinson disease, cancer | Cognitive capacity, OR: 1.844; 95% CI: 1.267, 2.683; P = 0.001 | |||
| Chewing and swallowing disorders | Functional decline, OR: 1.793; 95% CI: 1.163, 2.765; P = 0.008 | |||
| Mouth pain | Age, OR: 1.038; 95% CI: 1.001, 1.077; P = 0.045 | |||
| Complaints about the taste of the food | ||||
| Hunger | ||||
| Often leaves 25% of food uneaten | ||||
| Intake of dietary supplements | ||||
| Dental status | ||||
| Number of medications (last 7 d) | ||||
| Roberts et al., 2007 (29) | Sex | Baseline: 839 community subjects | ENS (low, moderate, or high risk of malnutrition classification) | Bivariate model: for malnutrition risk3 |
| Age at baseline | Follow-up: 779 community subjects | Sex (ref = female), OR: 0.83; 95% CI: 0.52, 1.32 | ||
| Highest level of education | Age (y), OR: 1.01; 95% CI: 0.95, 1.07 | |||
| Income satisfaction | Some high school education, OR: 1.00; 95% CI: 0.45, 2.20 | |||
| Medical conditions (chronic disease score) | High school education complete, OR: 1.49; 95% CI: 0.67, 3.32 | |||
| Measure of physical limitations | College or technical education, OR: 1.36; 95% CI: 0.60, 3.09 | |||
| Current health status, and status compared with the previous year | University education, OR: 1.21; 95% CI: 0.56, 2.62 | |||
| Psychological variables and distress | Income satisfaction (ref = no), OR: 0.60; 95% CI: 0.31, 1.14 | |||
| Type of housing | Physical limitations, OR: 1.12; 95% CI: 0.87, 1.44 | |||
| Number of cohabitants | ADL, OR: 1.26; 95% CI: 0.65, 2.45 | |||
| Marital status | IADL, OR: 1.61; 95% CI: 1.02, 2.55 | |||
| Perceived satisfaction with social support | Chronic disease score, OR: 1.02; 95% CI: 0.98, 1.07 | |||
| Stomach aches (ref = no), OR: 1.49; 95% CI: 0.89, 2.49; P value not given | ||||
| Dental problems (ref = no), OR: 1.39; 95% CI: 0.87, 2.22 | ||||
| Good current self-rated health (ref = excellent), OR: 1.66; 95% CI: 1.01, 2.75 | ||||
| Poor current self-rated health (ref = excellent), OR: 3.74; 95% CI: 1.65, 8.51 | ||||
| Worse self-rated health compared with the previous year (ref = the same), OR: 1.38; 95% CI: 0.62, 3.08 | ||||
| Better self-rated health compared with the previous year (ref = the same), OR: 0.55; 95% CI: 0.30, 0.99 | ||||
| Psychological distress (ref = low), OR: 1.35; 95% CI: 0.51, 3.60 | ||||
| Marital status (ref = not married), OR: 0.77; 95% CI: 0.48, 1.25 | ||||
| Satisfaction with social support (ref = no), OR: 0.56; 95% CI: 0.29, 1.08 | ||||
| 1 cohabitant (ref = 0), OR: 0.80; 95% CI: 0.49, 1.29 | ||||
| ≥2 cohabitants (ref = 0), OR: 1.61; 95% CI: 0.56, 4.63 | ||||
| Living in a house (ref = apartment), OR: 1.15; 95% CI: 0.69, 1.93 | ||||
| Living in a senior’s residence, OR: 1.45; 95% CI: 0.68, 3.10 | ||||
| Living in subsidized or nonprofit housing, OR: 0.94; 95% CI: 0.27, 3.33 | ||||
| Other kind of housing, OR: 3.29; 95% CI: 0.59, 8.47 | ||||
| Multivariable model: for malnutrition risk3 | ||||
| Sex (ref = female), OR: 0.93; 95% CI: 0.58, 1.51 | ||||
| Age (y), OR: 1.00; 95% CI: 0.94, 1.07 | ||||
| Good current self-rated health (ref = excellent), OR: 1.48; 95% CI: 0.87, 2.50 | ||||
| Poor current self-rated health (ref = excellent), OR: 3.30; 95% CI: 1.42, 7.67 | ||||
| Worse self-rated health compared with the previous year (ref = the same), OR: 1.09; 95% CI: 0.47, 2.50 | ||||
| Better self-rated health compared with the previous year (ref = the same), OR: 0.55; 95% CI: 0.30, 1.00 | ||||
| Jyrkkä et al., 2011 (30) | Polypharmacy status | Baseline: 294 community or institutionalized subjects | MNA-SF (≤11 = malnourished or at risk, ≥12 = well-nourished) | Linear mixed model: for decline in nutritional status (points compared with ref) |
| Residential status | Follow-up: 294 community or institutionalized subjects | Excessive polypharmacy (ref = nonpolypharmacy), β: −0.62; 95% CI: −0.98, −0.27; P = 0.001 | ||
| Self-reported health status | Age, β: −0.04; 95% CI: −0.08, −0.01; P = 0.016 | |||
| Nutritional status - MNA-SF | Institutionalized (ref = home), β: −1.89; 95% CI: −2.38, −1.39; P < 0.001 | |||
| Functional ability | Self-reported health status moderate (ref = good), β: −0.27; 95% CI: −0.49, −0.05; P = 0.016 | |||
| Cognitive capacity | Self-reported health status poor (ref = good), β: −1.05; 95% CI: −1.38, −0.73; P < 0.001 | |||
| Functional comorbidity index | Time of measurement 2005 (ref = 2004), β: −0.28; 95% CI: −0.50, −0.06; P = 0.011 | |||
| BMI > 30 | Time of measurement 2006 (ref = 2004), β: −0.42; 95% CI: −0.65, −0.20; P < 0.001 | |||
| Time of measurement 2007 (ref = 2004), β: −0.37; 95% CI: −0.60, −0.15; P = 0.001 | ||||
| Polypharmacy (ref = nonpolypharmacy), β: −0.12; 95% CI: −0.37, 0.13; P = 0.333 | ||||
| Male sex (ref = female), β: 0.11; 95% CI: −0.20, 0.42; P = 0.471 | ||||
| 0–6 y of education (ref = 7 y), β: −0.03; 95% CI: −0.32, 0.26; P = 0.823 | ||||
| Functional comorbidity index, β: 0.01; 95% CI: −0.08, 0.09; P = 0.950 | ||||
| Schilp et al., 2011 (16) | Education level | Baseline: 1120 subjects (98% living in the community) | BMI < 20 or self-reported involuntary weight loss ≥5% in the last 6 mo | Univariate model: for incidence of malnutrition3 |
| Cognitive functioning | Follow-up: 839 subjects | Light alcohol use, HR: 0.67; 95% CI: 0.46, 0.98 | ||
| Monthly household income | Female sex, HR: 1.40; 95% CI: 1.01, 1.92 | |||
| Depression | Loneliness, HR: 1.47; 95% CI: 1.06, 2.04 | |||
| Anxiety | No partner present, HR: 1.70; 95% CI: 1.24, 2.33 | |||
| Presence of chronic diseases (comorbidity) | Depressive symptoms, HR: 1.96; 95% CI: 1.32, 2.93 | |||
| Medication use | Anxiety symptoms, HR: 1.75; 95% CI: 1.11, 2.78; P value not given | |||
| Appetite during the last week | ≥2 chronic diseases, HR: 2.08; 95% CI: 1.31, 3.28 | |||
| Subjective pain | Poor appetite, HR: 1.99; 95% CI: 1.32, 3.00 | |||
| Problems biting and chewing | Limitations performing normal activities because of a health problem, HR: 1.76; 95% CI: 1.28, 2.43 | |||
| Limitation of normal activities because of a health problem | ≥3 medications, female, HR: 2.57; 95% CI: 1.50, 4.38 | |||
| Physical performance | Low physical performance test score (<75 y old), HR: 0.89; 95% CI: 0.81, 0.96 | |||
| Difficulty walking stairs | Difficulty walking stairs (<75 y old), HR: 2.50; 95% CI: 1.59, 3.91 | |||
| Smoking status | Pain data missing, female, HR: 1.62; 95% CI: 1.01, 2.61 | |||
| Alcohol use | Age ≥ 75 y, HR: 1.30; 95% CI: 0.95, 1.79 | |||
| Physical activity in the previous 2 wk | Medium education, HR: 0.78; 95% CI: 0.56, 1.09 | |||
| Visual or hearing impairment | High education, HR: 0.94; 95% CI: 0.56, 1.58 | |||
| Loneliness | Medium income, HR: 0.98; 95% CI: 0.66, 1.44 | |||
| Individuals without a partner inside or outside the household | High income, HR: 0.89; 95% CI: 0.57, 1.39 | |||
| Type of housing (independent and nonindependent living) | Missing income data, HR: 0.93; 95% CI: 0.54, 1.62 | |||
| Poor cognitive status, HR: 0.94; 95% CI: 0.49, 1.78 | ||||
| 1 chronic disease, HR: 1.23; 95% CI: 0.76, 2.00 | ||||
| 1–2 medications, male, HR: 0.47; 95% CI: 0.23, 0.95 | ||||
| 1–2 medications, female, HR: 0.36; 95% CI: 0.76, 2.41 | ||||
| ≥3 medications, male, HR: 1.51; 95% CI: 0.86, 2.66 | ||||
| Pain, male, HR: 1.29; 95% CI: 0.70, 2.37 | ||||
| Pain, female, HR: 1.37; 95% CI: 0.82, 2.27 | ||||
| Pain data missing, male, HR: 0.62; 95% CI: 0.29, 1.33 | ||||
| Frequent problems biting or chewing, HR: 1.81; 95% CI: 0.57, 1.16 | ||||
| Missing data on problems biting or chewing, HR: 0.83; 95% CI: 0.52, 1.32 | ||||
| Vision problems, HR: 1.00; 95% CI: 0.65, 1.52 | ||||
| Hearing problems, HR: 1.42; 95% CI: 0.93, 2.16 | ||||
| Low physical performance test score (≥75 y old), HR: 1.01; 95% CI: 0.92, 1.11 | ||||
| Difficulty walking stairs (≥75 y old), HR: 1.08; 95% CI: 0.67, 1.75 | ||||
| Former smoker, HR: 0.82; 95% CI: 0.50, 1.33 | ||||
| Current smoker, HR: 1.08; 95% CI: 0.73, 1.61 | ||||
| Moderate alcohol use, HR: 0.82; 95% CI: 0.52, 1.30 | ||||
| Excessive alcohol use, HR: 1.16; 95% CI: 0.52, 2.58 | ||||
| Physical activity, HR: 0.99; 95% CI: 0.997, 1.000 | ||||
| Independent housing, HR: 3.13; 95% CI: 0.44, 22.33 | ||||
| Multivariate model: for incidence of malnutrition3 | ||||
| Poor appetite, HR: 1.63; 95% CI: 1.02, 2.61 | ||||
| Difficulty walking stairs (<75 y old), HR: 1.91; 95% CI: 1.14, 3.22 | ||||
| 1–2 medications, female (interaction with sex), HR: 0.39; 95% CI: 0.18, 0.83 | ||||
| Female sex, HR: 0.73; 95% CI: 0.38, 1.39 | ||||
| Age ≥ 75 y, HR: 0.88; 95% CI: 0.29, 2.63 | ||||
| Depressive symptoms, HR: 0.89; 95% CI: 0.52, 1.52 | ||||
| Anxiety symptoms, HR: 1.26; 95% CI: 0.72, 2.21 | ||||
| 1 chronic disease, HR: 1.10; 95% CI: 0.64, 1.88 | ||||
| ≥2 chronic diseases, HR: 1.32; 95% CI: 0.75, 2.33 | ||||
| 1–2 medications, male, HR: 1.10; 95% CI: 0.60, 2.02 | ||||
| ≥3 medications, male, HR: 1.80; 95% CI: 0.99, 3.27 | ||||
| ≥3 medications, female, HR: 1.03; 95% CI: 0.54, 1.96 | ||||
| Limitations of normal activities due to a health problem, HR: 1.20; 95% CI: 0.81, 1.77 | ||||
| Low physical performance test score, age < 75 y, HR: 0.98; 95% CI: 0.89, 1.08 | ||||
| Low physical performance test score, age ≥ 75 y, HR: 1.06; 95% CI: 0.95, 1.18 | ||||
| Difficulty walking stairs (≥75 y old) (interaction with age), HR: 0.88; 95% CI: 0.51, 1.50 | ||||
| Light alcohol use, HR: 0.82; 95% CI: 0.55, 1.96 | ||||
| Moderate alcohol use, HR: 1.11; 95% CI: 0.67, 1.83 | ||||
| Excessive alcohol use, HR: 1.42; 95% CI: 0.58, 3.46 | ||||
| Loneliness, HR: 1.11; 95% CI: 0.75, 1.64 | ||||
| Partner present, HR: 1.37; 95% CI: 0.92, 2.02 | ||||
| Serra-Prat et al., 2012 (31) | Age | Baseline: 254 community subjects (69 subjects with OD and 185 without OD); Follow-up: 227 community subjects | MNA (>23.5 = well nourished, ≤23.5 = malnourished or at risk of malnutrition) | Logistic regression: for M/RM |
| Sex | Basal OD (on prevalence of M/RM), OR: 2.72; 95% CI: 1.25, 5.95; P = 0.010 | |||
| Education | Impaired efficacy of swallow (on prevalence of M/RM), OR: 2.73; 95% CI: 1.19, 6.26; P = 0.015 | |||
| Family support | Basal OD (on weight loss > 5%), OR: 1.33; 95% CI: 0.55, 3.24; P = 0.336 | |||
| Toxic habits | Impaired efficacy of swallow (on weight loss > 5%), OR: 1.30; 95% CI: 0.49, 3.46; P = 0.380 | |||
| Comorbidities | Effect adjusted by age, Barthel score, basal nutritional status: | |||
| Physical exploration (weight, height, waist circumference, and handgrip strength) | Impaired efficacy of swallow, OR: 2.31; 95% CI: 0.96, 5.57; P = 0.062 | |||
| Functional capacity | Age, OR: 1.03; 95% CI: 0.96, 1.08; P = 0.448 | |||
| Nutritional status | Barthel score, OR: 0.99; 95% CI: 0.95, 1.02; P = 0.443 | |||
| Frail condition | M/RM at baseline, OR: 0.70; 95% CI: 0.26, 1.89; P = 0.481 | |||
| Loss of >5% of initial handgrip strength, male, OR: 2.33; 95% CI: 1.02, 5.36; P = 0.043 |
1
All studies (16, 27–31) are from Europe, except Shatenstein et al. (27), which is from North America. ADL, activities of daily living; ENS, Elderly Nutrition Screening tool; IADL, instrumental activities of daily living; MNA, Mini Nutritional Assessment; MNA-SF, Mini Nutritional Assessment-Short Form; M/RM, malnutrition/risk of malnutrition; OD, oral dysphagia; ref, reference; β, standardized regression coefficient.
2
95% CI values not given.
3
P values not given.