Table 2.

Nutritional status and biomarkers in patients with hip fracture.

Authors Origin Publication Year	Design Aim Setting	n (Male/Female) Age, Mean ± SD (Years) BMI (kg/m2)	Anthropometry Measurement of Body Composition Biomarkers	(1) Exclusion Criteria (2) Definition of Malnutrition	Main Outcomes
Mansell UK 1990 [33]	Observational Comparison of anthropometric measurements of women with HF, with healthy volunteers in the community (C) and patients admitted to geriatric wards (G)	n 663 (0/663) HF 470 Community 103 Geriatric 90	MAC (cm) HF 22.8 ± 0.2 Community 28.6 ± 0.27 Geriatric 25.9 ± 0.41	(1) For healthy female: housebound or wheelchairs (2) NA	Fractured group were older than healthy subjects (p < 0.001). HF vs. Community: ↓ MAC ↓ AMA ↓↓ TSF ↓↓ AFA (p < 0.001) Significant MAC reduction per year of age: −0.20 ± 0.03 cm/year (HF) −0.15 ± 0.06 cm/year (Community) Significant TSF reduction per year of age: −0.16 ± 0.03 mm/year (HF)
		HF = 77.3 ± 0.3 years Community 72.5 ± 0.5 years Geriatric 79.1 ± 0.8 years	TSF (mm) HF 13.0 ± 0.6 Community 24.7 ± 0.6
Maffulli UK 1999 [20]	Observational Nutritional differences in patients with intertrochanteric (IT) and intracapsular (IC) fractures	n 119 (91/28) IT 17–54 IC 11–37 80.8 ± 9.1 years 21.5 ± 4.1 kg/m2	Intertrochanteric TSF 11.6 ± 4.5 mm BSF 6.1 ± 4 mm MAC 23.5 ± 3.6 cm Intracapsular TSF 10.6 ± 4 mm BSF 5.4 ± 2.4 mm MAC 21.9 ± 3.1cm	(1) Pathologic fracture (2) BMI < 18 kg/m2	Malnourished → 45% IC vs. 20% IT (p < 0.001) 19% Overweight or obese → 22% IT vs. 2% IC Complications 15% IC vs. 3% IT (p < 0.05) BMI: IC < IT (20.1 ± 3.3 vs. 22.5 ± 4.6 kg/m2, p < 0.01)
Murphy UK 2000 [15]	Observational Assess the sensitivity and specificity of MNA, and its comparability with other nutritional tools	n 49 (0/49) 79.5 ± 9 years 23.7 ± 4.3 kg/m2	Albumin 36.9 ± 4.7 g/L	(1) Cognitive impairment (2) MNA	Patients had low mean values for body weight, albumin and transferrin Mean energy intake was below the estimated average requirementMNA < 17: Sensitivity: 27–57% Specificity: 66–100%
Lumbers UK 2001 [12]	Cross-sectional Intake and nutritional status in HF compared to day center attendees (DC)	n 125 HF 75 (0/75) DC 50 (0/50) 80.2 ± 7.9 years 25.5 ± 4.8 kg/m2	HF MAC 27.1 ± 4.3 cm TSF 17 ± 2.7 mm MUAMC 21.4 ± 3.4 cm Day Centers MAC 31.3 ± 4.7 cm TSF 18.9 ± 2.8 mm MUAMC 23.3 ± 3.8 cm	(1) Mental function test < 7 (2) NA	HF patients vs. day center attendees have: lower BMI (24.1 ± 4.7 vs. 27.5 ± 4.9 kg/m2, p < 0.001); lower MUAMC, albumin, proteins and energy intake and higher CRP (p < 0.01) Albumin ↔ RCP (r = −0.45)
Nematy UK 2006 [14]	Observational Nutritional status and energy intake	n 25 (7/18) 85.3 ± 1.5 years 21.9 ± 1.0 kg/m2	Albumin 36 ± 2.6 g/L	(1) Pathological fracture or elective surgery (2) Changes in dietary intake, weight loss, pressure sore, infection, and need help for eating	At risk of malnutrition group (n 17) had lower BMI and lower energy intake versus well-nourished group (n 8) BMI: ARM 19.6 ± 1.1 vs. WN 25 ± 1.5 kg/m2 Energy intake: ARM 3602 ± 320 vs. WN 5044 ± 528 kJ/day
Perez Spain 2010 [19]	Observational Prevalence of malnutrition	n 80 (24/56) 80.6 ± 6.3 years 27.1 ± 4.4 kg/m2	TSF 5.5 ± 2.3 mm BSF 8.1 ± 4.8 mm MAC 26.8 ± 3.9 mm CC 31.9 ± 4 cm	(1) NA (2) MNA	Length of hospital stay: men 15.3 ± 5.8 days; women 14.9 ± 12 days MNA ↔ BMI r = 0.6
Perez Spain 2011 [13]	Observational Nutritional status and intake of HF vs. community dwelling study participants	n 86 (0/86) HF = 44 Community = 42	MAC (cm) HF 27.3 ± 3.2 Community 29.1 ± 4.1	(1) No osteoporotic fractures or major trauma (2) NA	HF has lower BMI, arm and leg circumference than community dwelling (p < 0.05) Energy intake (kcal): HF 1417; community dwelling 2052 (p < 0.001) Calcium (mg/dL): HF 827; community dwelling 1265 (p < 0.001) Vitamin D (μg/dL): HF 1.6; community dwelling: 5.2 (p < 0.001)
		Age HF = 77.9 ± 4.7 years Community = 76.2 ± 4.6 years
			Calf circumference (cm) HF 32.5 ± 3.6 Community 35.1 ± 4.4
		BMI kg/m2 HF = 27.6 ± 3.7 Community = 31.3 ± 4.6
Koren-Hakim Israel 2012 [18]	Retrospective Association of MNA-SF with functional status, comorbidity, and mortality (36 months)	n 215 (61/154) 83.5 ± 6.1 years 26.4 ± 4.9 kg/m2	WN28.1 ± 4.0 kg/m2 ARM 25.5 ± 5.1 kg/m2 MN 22.7 ± 3.7 kg/m2	(1) Terminal illnesses and multi-trauma (2) MNA	MNA ↔ BMI, ADL, cognitive status, readmission, mortality 36 m, CCI and CIRS-G Independent variables for mortality → Charlson comorbidity index and functional status (ADL)
Villani Germany 2013 [34]	Cross-sectional Evaluate new screening tool for detection cachexia	n 71(19/52) 82.2 ± 5.8 years Men 23.9 ± 2.9 kg/m2 Women 25.9 ± 3.8 kg/m2	M: MAC (cm) 26.7 ± 3.3 TSF (mm) 11.5 ± 4.8 W: MAC (cm) 27.1 ± 3.9 TSF (mm) 16.4 ± 5.4	(1) Pathological fracture or malignancy, residing in residential care (2) NA	Patients with cachexia: 5 new tool 4 (consensus definition) New tool: Sensitivity 75% and specificity 97% Positive predictive value 60%, negative predictive value 99%
Bell Australia 2014 [35]	Prospective Concurrent and predictive validity of malnutrition diagnostic measures	n 142 (45/97) 83.5 years	NA	(1) NA (2) MNA-SF < 8 BMI < 18.5 kg/m2 ALB < 35 g/L ICD10-AM Geriatrician (subjective clinical assessment)	Malnutrition prevalence with different tools: BMI (12.7%), MNA-SF (27%), ICD10-AM (48.2%), Albumin (53.2%), subjective assessment (55.1%) MNA-SF ↔ ICD10-AM (r = 0.3) and BMI (r = 0.2) ICD10-AM ↔ subjective assessment (r = 0.6) ICD10-AM independent predictor of 4-month mortality (OR 3.6, 95%CI 1.1–11.8)

ADL: activities of daily living; AFA: arm fat area; AMA: arm muscle area; ARM: at risk of malnutrition; BMI: body mass index; BSF: biceps skinfold; CIRS-G: cumulative illness rating scale for geriatrics; CRP: C-reactive protein; HF: hip fracture; ICD10-AM: international classification of disease 10th revision-Australian modification; MAC: mid-arm circumference; MN: malnourished; MNA: Mini Nutritional Assessment; MUAMC: mid-upper arm muscle circumference; TSF: triceps skinfold; WN: well-nourished. . ↓: lower; ↓↓ much lower; ↔: correlation.