Appendix I – PREVALENCE OF MALNUTRITION – Tables A1.1 to A1.8
Table A1.1
Prevalence of malnutrition or risk of malnutrition in some examples of studies reported after 2002 according to country and healthcare setting – hospital (general)
| Country | Author (year) | Study population | Patients (n) | Healthcare setting (and timing of nutritional screening/assessment) | Prevalence % (risk category) | Method and details of risk category where reported |
|---|---|---|---|---|---|---|
| EUROPE | ||||||
| Bosnia-Herzegovina | Vanis & Mesihovic (2008)1 | Randomly chosen hospitalised patients | 2200 | Hospital (during hospital stay) | 58.3 52 55.3 |
‘MUST’ (no further details given) Nutrition Risk Screening 2002 (NRS-2002) (no further details given) MNA (no further details given) |
| Denmark | Rasmussen et al. (2004)2 | > 14 years of age | 590 | Hospital – internal medicine, gastro and orthopaedic surgery (hospitalised patients on the specific day of investigation) | 39.9 | NRS-2002 but note no adjustment made for age |
| Denmark | Kondrup et al. (2002)3 | > 15 years of age | 740 | Hospital – university, regional & local (on admission) | 22 | Nutritionally at risk = score ≥ 3. Severe malnutrition = score 3 (BMI < 18.5 kg/m2, recent weight loss > 5% in the last month or an intake of 0–25% of requirement). Moderate malnutrition = score 2 (BMI 18.5–20.5 kg/m2, recent weight loss > 5% in the last 2 months or an intake of 25–50% of requirement). Slight malnutrition = score 1 (recent weight loss > 5% in the last 3 months or an intake of 50–75% of requirement). Patients’ general condition and disease severity also taken into account |
| Germany | Pirlich et al. (2006)4 | > 18 years of age | 1886 | Hospital – community, teaching & university (on admission) | 27.4 (17.6 + 9.8) | SGA (moderate + severe) |
| Germany | Pirlich et al. (2003)5 | > 18 years of age | 502 | Hospital – university & district (on day of admission) | 24.2 | SGA (moderate + severe). Not reported separately |
| Hungary | Lelovics et al. (2008)6 | All adult patients | 1266 | Hospital – teaching (on admission) | 41 (13 + 28) | ‘MUST’ (medium + high) |
| Iceland | Westergren et al. (2010)7 | All adults > 18 years of age | 95 (2006) 92 (2007) |
Hospital (point prevalence on specified day in 2006 & 2007) | 25 (2006) 17 (2007) |
Nutritionally at risk defined by presence of at least 2 of: involuntary weight loss; BMI < 20 kg/m² if ≤ 69 years, BMI < 22 kg/m² if ≥ 70 years; eating difficulties according to Minimal Eating Observation Form Version II |
| Italy | Cereda et al. (2010)8 | > 18 years of age | 559 | Regional hospitals with >400 beds (within 36 hours of admission) | 57.2 | NRS-2002 |
| Italy | Lucchin et al. (2009)9 | Adults aged > 18 years of age | 1284 | Regional hospitals with > 400 beds (within 36 hours of admission) | 28.6 | NRS-2002. At risk of malnutrition = score ≥ 3 |
| The Netherlands | van Vliet et al. (2020)10 | Adults aged ≥18 years | 584 | University hospital (on admission, day 5, day 10, and ≥ day 15) | 31 (at admission; stage B/C) 56 (day 5) 66 (day 10) 79 (≥ day 15) 36 (predischarge; stage B/C) |
PG-SGA (Categories: A = well nourished, B = moderate/suspected malnutrition, C = severely malnourished) |
| Poland | Dzieniszewski et al. (2005)11 | Adults aged 16–100 years of age | 3310 | Hospital – teaching, provincial & county (first day of admission & day of discharge) | 10.43 (admission), 11.21 (discharge) | BMI (classification of risk of malnutrition BMI < 20 kg/m²) |
| Poland | Ostrowska et al. (2021)12 | > 6 years of age | 498 | Hospital (not specified) | 9.4 | ESPEN diagnostic criteria for malnutrition (2015). Step 1: MST (≥ 2 indicating risk of malnutrition). Step 2: BMI (< 18.5 kg/m² indicating malnutrition) OR unintended body weight loss (>5% within the last 3 months or >10% within an unspecified time frame) and BMI (< 20 kg/m² for subjects < 70 years and < 22 kg/m² for subjects > 70 years). |
| Portugal | Amaral et al. (2010)13 | > 18 years of age | 1144 | Hospital – university, district & oncology (on admission) | 36 | NRS-2002 |
| Portugal | Amaral et al. (2007)14 | > 18 years of age | 469 | Hospital (on admission) | 42 | NRS-2002 (based on BMI, % recent weight loss, recent change in food intake and disease severity). Mild/slight: score 1, moderate: score 2, severe: score 3. For patients > 70 years of age, one point was added to the score. Patients with a total score of ≥ 3 were considered nutritionally at risk, patients with a score < 3 were not considered nutritionally at risk |
| Republic of Ireland | Russell & Elia (2012)15 (spring 2011) | Adults ≥ 18 years of age | 1102 | Hospital (within 72 hours of admission) | 27 (7 + 20) | ‘MUST’ (medium + high) |
| Republic of Ireland | Russell & Elia (2011)16 (winter 2010) | Adults ≥ 18 years of age | 1602 | Hospital (within 72 hours of admission) | 33 (8 + 25) | ‘MUST’ (medium + high) |
| Spain | Velasco et al. (2011)17 | ≥ 18 years of age | 400 | University hospitals (within 36 hours of admission) | 34.5 31.5 (14 +17.5) 35.3 (28.5 + 6.8) 58.5 (44 + 14.5) |
NRS-2002 ‘MUST’ (medium + high) SGA (suspected malnourishment + severe) MNA (at risk + poor nutritional status) |
| Spain | Martinez Olmos et al. (2005)18 | > 18 years of age | 360 | Hospital (stratified random sample of hospitalised patients on specified days) | 46.9 (37.2 + 9.7) | SGA (moderate + severe) |
| Spain | Planas et al. (2004)19 | Adult patients | 400 | Hospital – university-affiliated (within 48 hours of admission) | 26.7 (anthropometry) 46 (SGA) |
Anthropometry (classification as undernourished: BMI < 18.5 kg/m2 or BMI < 20 kg/m2 and TSFT or Arm Muscle Circumference < 15th centile) SGA (moderate + severe). Not reported separately |
| Spain | Pablo et al. (2003)20 | > 18 years of age | 60 | Hospital – public general (within 48 hours of admission) | 63.3 (36.7, 18.3 + 8.3) SGA 90 (6.7, 60 + 23.3) Nutritional Risk Index 80 (20, 15 + 45) INA 78.3 Combined Index |
SGA (mild, moderate + severe)
NRI: 1.519 x serum albumin (g/l) + 41.7 x (present/usual weight)) (mild: NRI 97.5–100, moderate: NRI 83.5 to < 97.5, severe: NRI < 83.5 Instant Nutritional Assessment (INA) 1st degree: serum albumin ≥ 3.5 g/dl; blood lymphocyte count < 1500 cells/mm3, 2nd degree: serum albumin < 3.5 g/dl; blood lymphocyte count < 1500 cells/mm3, 3rd degree: serum albumin < 3.5 g/dl; blood lymphocyte count ≥ 1500 cells/mm3, 4th degree serum albumin < 3.5 g/dl; blood lymphocyte count < 1500 cells/mm3 |
| Sweden | Westergren et al. (2009)21 | >18 years of age | 1197 824 370 |
Large hospitals > 500 beds Medium hospitals 200–500 beds Small hospitals < 200 beds (point prevalence, data collected on hospitalised patients on a single day) |
34 (26.4 + 7.6) 26.2 (21.1 + 5.1) 21.6 (17.7 + 3.9) |
Moderate/high risk of under-nutrition defined as the occurrence of at least two of: involuntary weight loss, BMI below limit (BMI < 20 kg/m2 if ≤ 69 years, BMI < 22 kg/m2 if ≥ 70 years), eating difficulties according to Minimal Eating Observation Form – Version II |
| Sweden | Westergren et al. (2008)22 | All patients | 874 | Hospitals (hospitalised patients, timing not specified) | 27 | At risk of under-nutrition if 2–3 of the following 3 criteria fulfilled: (1) involuntary weight loss (irrespective of time and amount), (2) BMI below limit (< 20 kg/m2 if ≤ 69 years, < 22 kg/m2 if ≥ 70 years), and (3) presence of eating difficulties. Low risk: 1 criterion fulfilled, moderate risk: 2 criteria fulfilled, high risk: 3 criteria fulfilled. Not reported separately |
| Switzerland | Imoberdorf et al. (2010)23 | All adult medical admissions | 32837 | Hospital (on day of admission) | 18.2 (range 13–20% across 7 participating hospitals) | NRS-2002. Severe under-nutrition or high risk for developing under-nutrition: score ≥ 3 |
| Switzerland | Venzin et al. (2009)24 | All medical admissions | 430 | Hospital – medium- sized general teaching (MNA within 24 hours of admission, physician’s assessment on admission) | 30.5 (20.1 + 10.4) 14 |
MNA. At risk of malnutrition: score of 17–23.5, frank malnutrition score of < 17 Physician’s assessment (judgement based on patient history, physical examination and laboratory results) |
| Switzerland | Kyle et al. (2006)25 | All adult medical/surgical admissions | 995 | Hospital (on hospital admission) | 39 (29 + 10)
37 (10 +27) 28 (19 + 9) 25 (20 + 5) |
SGA (moderate + severe) MUST (medium + high) NRS-2002 (medium + high risk) NRI (medium + high risk) (1.519 x serum albumin g/l) = (14.7 x present/usual body weight [BW]). NRI score > 100 indicates no risk, 97.5–100 low risk, 83.5–97.5 medium risk, ≤ 83.5 high risk |
| Switzerland | Kyle et al. (2002)26 | All adult medical/surgical admissions | 995 | Hospital (within 3 hours of admission) | 61.4 (38.3 + 23.1) | SGA (moderate + severe) |
| The Netherlands | Meijers et al. (2009)27 | ≥ 18 years of age | 8028 | Hospital (cross-sectional, point prevalence on specified day) | 23.8 | Malnutrition defined according to one of the 3 following criteria: (1) BMI < 18.5 kg/m2 (2) unintentional weight loss(6 kg in previous 6 months or 3 kg in the previous month) or (3) BMI 18.5–20 kg/m2 in combination with no nutritional intake for 3 days or reduced intake for > 10 days |
| The Netherlands | Bavelaar et al. (2008)28 | All newly admitted patients | 395 | Hospital general medical wards (within 72 hours of admission) | 31.9 (31.1 + 0.8) | BMI and/or SNAQ score (severe: BMI < 18.5 kg/m2 and/or SNAQ score ≥ 3 points + moderate: BMI 18.5–20.0 kg/m2 and/or SNAQ score ≥ 2 points) |
| The Netherlands | Kruizenga et al. (2003)29 | > 18 years of age | 6150 | Hospital (convenience sample, timing not clear) | 26 (13 + 13) | Involuntary weight loss (at risk: 5–10% unintentional weight loss during the past 6 months + malnourished: unintentional weight loss > 10% during the past 6 months) |
| Turkey | Nursal et al. (2005)30 | All adult patients admitted to wards | 2211 | University referral centre (within 48 hours of admission) | 11 15.6 |
SGA (moderate + severe). Not reported separately Combination criteria: diagnosed with malnutrition if positive for at least 2 of the following 6 criteria: (1) > 10% weight loss during the past 6 months; (2) BMI < 20 kg/m2; (3) TSFT no higher than the 5th centile; (4) MAMC no higher than the 5th centile; (5) serum albumin level < 3 g/dl; and (6) serum prealbumin level < 0.2 g/dl |
| UK | Lamb et al. (2009)31 | Adult inpatients ≥ 16 years of age | 328 226 |
Hospital – general medicine, general surgery, orthopaedics and critical care (all patients assessed on a single day) | 43.9 (11.9 + 32) 32.7 (19 + 13.7) |
‘MUST’ (medium + high) Northumbria Nutrition Score Chart (NNSC) validated for reproducibility and ease of use only. Patients scored according to psychological state, BMI, weight loss, ability to swallow, and co-morbid medical illness. Low risk of malnutrition: 0-3, moderate risk: 4–5, high risk: ≥ 6 |
| UK | Russell & Elia (2012)15 (spring 2011) | Adults ≥ 18 years of age | 7541 | Hospital (within 72 hours of admission) | 25 (7 + 18) | ‘MUST’ (medium + high) |
| UK | Russell & Elia (2011)16 (winter 2010) | Adults ≥ 18 years of age | 9669 | Hospital (within 72 hours of admission) | 34 (14 + 21) | ‘MUST’ (medium + high) |
| UK | Russell & Elia (2009)32 (summer 2008) | Adults ≥ 18 years of age | 5089 | Hospital (within 72 hours of admission) | 28 (6 + 22) | ‘MUST’ (medium + high) |
| UK | Russell & Elia (2008)33 (autumn 2007) | Adults ≥ 18 years of age | 9336 | Hospital (within 72 hours of admission) | 28 (6 + 22) | ‘MUST’ (medium + high) |
| USA & CANADA | ||||||
| Canada | Singh et al. (2006)34 | Adults ≥ 20 years of age | 48 | Hospital – medical admission/teaching unit (within 10 days of admission) | 69 (39 + 30) | SGA (moderate + severe) |
| USA | Robinson et al. (2003)35 | ≥ 18 years of age | 320 | Hospital – tertiary (blood taken within 48 hours of admission & nurse screening within 24 hours of admission) | 51 33 |
Plasma prealbumin concentration Standard hospital nutrition screening/assessment protocol (nursing screening questionnaire regarding nutritional status and nutritional intake). If any positive responses, a dietitian informed and perform a formal nutrition assessment within 48 hours |
| USA | Liang et al. (2008)36 | Adults 18–80 years of age | 200 | Hospitals – teaching, Baltimore, USA (newly admitted + 2 weeks post admission or discharge) | 51 (admission) 41.4 (discharge or 2 weeks post discharge) |
NRS-2002 |
| USA | Sauer et al. (2019)37 | ≥ 18 years of age | 9959 | Hospital (not specified) | 32.7 | MST |
| CENTRAL & SOUTH AMERICA | ||||||
| Argentina | Wyszynski et al. (2003)38 | Adults > 18 years of age | 997 | Hospital (not specified June- November 1999) | 47.3 (36.1 + 11.2) | SGA (moderate + severe) |
| Brazil | Leandro-Merhi et al. (2011)39 | Adults 20-60 years of age | 230 | Hospital – surgical wards (preoperatively) | 20.1 (19.3 + 0.8) | SGA (slightly malnourished + moderately malnourished) |
| Brazil | Correia & Campos (2003)40 | Adults > 18 years of age | 9348 | Hospitals – general and at least 200 beds | 50.2 (39.0 + 11.2) | SGA (moderate + severe) |
| Cuba | Barreto Penié (2005)41 | Adults > 19 years of age | 1905 | Hospitals – secondary & tertiary (not specified) | 41.2 (30.1 + 11.1) | SGA (moderate + severe) |
| Colombia | Cardenas et al. (2020)42 | ≥ 18 years of age | 7994 | Hospital (not specified) | 38 | MST |
| ASIA | ||||||
| China | Liang et al. (2008)36 | Adults 18–80 years of age | 300 | Hospitals – teaching (newly admitted and 2 weeks post admission or discharge) | 39 (admission), 38.5 (discharge or 2 weeks post admission) | NRS-2002 |
| China | Zhou et al. (2024)43 | ≥ 18 years of age | 5821 | Hospital (not specified) | 22.8 | GLIM criteria |
| Singapore | Lim et al. (2011)44 | Adults 18–74 years of age | 818 | Acute tertiary hospital (within 48 hours of admission) | 29 (25+4) | SGA (moderate + severe) |
| Singapore | Raja et al. (2004)45 | Adults | 715 (admission episodes) 681 (patient episodes) 152 (cases) |
Hospitals – medical & surgical wards(within 72 hours of admission by dietitian using MST) | 14.7 22.3 69.1 (37.5+31.6) |
Those episodes identified as at risk of malnutrition/malnourished by both MST and SGA Initial assessment by dietitians using Ferguson, Bauer, Banks & Capra MST. MST is a questionnaire developed and validated in an Australian hospital. Patients are scored based on the following criteria: recent weight loss; if yes, how much; eating poorly due to decreased appetite? Score ≥ 2 classified as at risk of malnutrition SGA (moderate + severe) |
| Vietnam | Pham et al. (2006)46 | Abdominal surgery patients | 438 total of which major surgery 274 | Hospital – general (not specified) | 55.7 (28.8+26.9) 77.7 (35.4+42.3) |
SGA (moderate + severe) SGA (moderate + severe) |
| MIDDLE EAST | ||||||
| Iran | Hosseini et al. (2006)47 | ≥ 18 years of age | 156 | Hospital > 400 beds (within 24 hours of admission + on discharge) | 5.8 (admission) 10.9 (discharge) 0.6 (admission) 1.3 (discharge) |
BMI severely undernourished < 16 kg/m2 BMI undernourished < 18.5 kg/m2 |
| AUSTRALIA & NEW ZEALAND | ||||||
| Australia & New Zealand | Agarwal et al. (2012)48 | ≥ 18 years of age | 3080 | Acute care hospitals (data collected over 1–3 24-hour periods during June & July 2010) | 32 30 (24 + 6) 8 41 |
Combined SGA + BMI SGA (suspected/moderate + severe) BMI < 18 kg/m². Malnutrition risk (MST). |
| Australia | Thomas et al. (2007)49 | > 18 years of age | 64 | Hospital Acute Admissions Unit (within 48h of admission) | 53 (43.8 + 9.4) | Patient Generated-SGA (PG-SGA) (moderately malnourished + severely malnourished). An extension of SGA, with a higher numerical score reflecting a greater risk of deterioration of nutritional status. PG-SGA global rating can identify malnutrition, and the score is used to assess subtle changes in nutritional status/nutritional risk that cannot be detected by SGA. (No further details given) |
| Australia | Lazarus & Hamlyn (2005)50 | ≥ 18 years of age | 324 | Hospital: not-for-profit private (August-October 1999) | 42.3 (36.4 + 5.9) | SGA (moderate + severe) |
| Australia | Banks et al. (2007)51 | All available subjects (excluding paediatric, obstetric, mental health and same-day patients) | 774 1434 |
Hospitals (a single day for each facility 2002 + 2003) | 34.7 (27.8 + 7.0) 31.4 (26.1 + 5.3) |
Mean MNA (moderate + severe) Mean MNA (moderate + severe) |
Table A1.2
Prevalence of malnutrition or risk of malnutrition in some examples of studies reported after 2002 according to country and healthcare setting – hospital (older people)
| Country | Author (year) | Study population | Patients (n) | Healthcare setting (and timing) | Prevalence % (risk category) | Method and details |
|---|---|---|---|---|---|---|
| EUROPE | ||||||
| Austria | Eglseer et al. (2020)52 | 65–79 and ≥80 years of age | 3702 65–79 years (n = 2320) ≥80 years (n = 1382) | Hospital (not specified) | Overall: 24.3, 65–79 years: 25.2, ≥80 years: 22.7 | ‘MUST’ (at risk) |
| Belgium | Vanderwee et al. (2011)53 | ≥ 75 years of age | 2094 | Hospital – geriatric wards (cross-sectional, 16th May–15th Jun 2007) | 31.9 (range 0–90.9% across participating wards) | MNA-SF |
| Germany | Volkert et al. (2010)54 | ≥ 75 years of age | 205 | Community hospital – geriatric ward (first day after admission) | 25.4 60 (34.6+ 25.4) 90.2 (60.0 + 30.2) 5.9 | BMI (undernourished <22 kg/m²). SGA (moderate + severe). MNA (at risk + undernourished). Clinical judgement of physician. |
| Italy | Orsitto et al. (2009)55 | > 65 years of age | 588 | Hospital – geriatric ward (on admission) | 82 (58 + 24) | MNA (at risk + malnourished) |
| Italy | Bonetti et al. (2017)56 | ≥ 65 years of age | 1066 | Hospital – medical and surgical wards (not specified) | 70.1 (48.7 +21.4) | MNA (at risk + malnourished) |
| Norway | Söderhamn et al. (2011)57 | > 65 years of age | 153, 154, 153, 158 | Hospital – medical wards (during first days on ward) | 60.8 (43.8 + 17) 64.9 44.4 62 (29.1 + 32.9) | MNA (at risk + undernourished)MNA-SF (at risk)NRS-2002 (at risk)Nutritional Form for the Elderly (Norwegian) (NUFFE-NO) (≥ 6 indicating medium risk of under-nutrition + ≥ 11 indicating high risk of under-nutrition). Ordinal scale containing 15 3-point items: weight loss, changes in dietary intake, appetite, intake of prepared food, portion size, intake of fruit and veg, possibility of obtaining food products, company at meals, activity, dental and swallowing difficulties, fluid intake, GI problems, eating assistance, number of drugs, difficulties in eating because of impaired health |
| Portugal | Cansado et al. (2009)58 | ≥ 65 years of age | 341 | Hospital – surgery (within 48h of admission, 24h of discharge) | 93.3 (0.0 + 93.3) admission 61.5 (8.2 + 53.3) discharge |
‘MUST’ (medium + high) |
| 77.9 (26.6 + 51.3) admission 77.1 (33.7 + 43.4) discharge |
MNA (at risk + undernourished) | |||||
| 190 | Hospital – medicine (within 48h of admission, 24h of discharge) | 92.6 (0.0 + 92.6) admission 50.9 (15.2 + 35.7) discharge |
‘MUST’ (medium + high) | |||
| 91.5 (48.9 + 42.6) admission 95.7 (44.7 + 51.0) discharge |
MNA (at risk + undernourished) | |||||
| Republic of Ireland | Russell & Elia (2012)15 | Adults ≥ 65 years | Total study population n = 1262, of which 51% aged ≥ 65 years. (‘MUST’ data only available for n = 1102) | Hospital (within 72h of admission) | 28 | ‘MUST’ (medium + high) |
| Republic of Ireland | Russell & Elia (2011)16 | Adults ≥ 65 years | Total study population n = 1636, of which 48% aged ≥ 65 years. (‘MUST’ data only available for n = 1602) | Hospital (within 72h of admission) | 34 | ‘MUST’ (medium + high) |
| Republic of Ireland | O’shea et al. (2017)59 | ≥70 years of age | 606 | Hospital (within 36h of admission) | 63 (45+18) | MNA-SF (at-risk + malnourished) |
| Spain | de Luis et al. (2011)60 | > 65 years of age | 493 | Hospital (not specified) | 72.1 (49.6+22.5) | MNA (at risk + undernourished) |
| Spain | de Luis & Lopez Guzman (2006)61 | > 70 years of age | 213 | Hospital internal medicine departments (randomly selected hospitalised patients) | 74.1 (23.9+50.2) | MNA (malnourished: score < 17 points + at risk: score 17–23.5) |
| Switzerland | Drescher et al. (2010)62 | 78–89 years of age | 104 | Hospital – geriatric ward (within 3 days of admission) | 70(48+22) 34 | MNA (at risk + undernourished) NRS-2002 |
| Switzerland | Imoberdorf et al. (2010)23 | Adults | Total study population n = 32,837, no details of number of patients aged > 65 years available | Hospital – general medical departments 65–84 years of age > 85 years of age (day of admission) | 22 28 | NRS-2002 NRS-2002 Patients ≥ 70 years were given an additional score point |
| UK | Russell & Elia (2012)15(winter 2011) | Adults ≥ 65 years of age | Total study population n = 9132, of which 56% aged ≥ 65 years. (‘MUST’ data only available for n = 7541) | Hospital (within 72h of admission) | 28 | ‘MUST’ (medium + high) |
| UK | Russell & Elia (2011)16 (winter 2010) | Adults ≥ 65 years | Total study population n = 9932, of which 59% aged ≥ 65 years. (‘MUST’ data only available for n = 9669) | Hospital (within 72h of admission) | 39 | ‘MUST’ (medium + high) |
| UK | Russell & Elia (2009)32 (summer 2008) | Adults ≥ 65 years | Total study population n = 6068, of which 52% aged ≥ 65 years. (‘MUST’ data only available for n = 5089) | Hospital (within 72h of admission) | 32 | ‘MUST’ (medium + high) |
| UK | Russell & Elia (2008)33 (autumn 2007) | Adults ≥ 65 years | Total study population n = 9563, of which 55% aged ≥ 65 years. (‘MUST’ data only available for n = 9208) | Hospital (within 72h of admission) | 30 | ‘MUST’ (medium + high) |
| UK | Stratton et al. (2006)63 | Acutely ill older people | 150 | Hospital elderly care wards (within 48-72 hours of admission) | 58 (17+41) | ‘MUST’ (medium + high) |
| UK | Han et al. (2021)64 | Patients admitted with a hip fracture; ≥60 years of age | 1239 | Hospital (on admission) | 24.1 (at risk of malnourished), 8.1 (malnourished) | ‘MUST’ (medium + high) |
| USA & CANADA | ||||||
| USA | Covinsky et al. (1999)65 | > 70 years of age | 369 | Hospital – general medical unit (between 2nd & 4th day after discharge) | 40.7 (24.4+16.3) | SGA (moderate + severe) |
| CENTRAL & SOUTH AMERICA | ||||||
| Brazil | Leandro-Merhi et al. (2011)39 | ≥ 60 years of age | 120 | Hospital – surgical wards (preoperatively) | 43.9 (32.9+11.0) | MNA (at risk + malnourished) |
| Brazil | Coelho et al. (2006)66 | ≥ 60 years of age | 192 | Hospital – geriatric unit (between October 2004 & March 2005) | 29.7 54.7 |
BMI (WHO classification underweight < 18.5 kg/m2) BMI (Nutrition Screening Initiatives classification underweight < 22 kg/m2) |
| ASIA | ||||||
| China | Lei et al. (2009)67 | > 60 years of age | 184 | Hospital (within 5 days of admission) | 72.8 (53.2+19.6) | MNA (at risk + malnourished) |
| China | Shum et al. (2005)68 | ≥ 60 years of age | 77 120 |
Convalescent & rehabilitation hospital – geriatric wards (within 48 hours of admission) | 61.1 (44.2+16.9) 16.7 |
Chinese MNA (at risk: 18.5–23.5 + malnourished: score < 18.5) (no further details given) BMI < 18.5 kg/m2 and albumin level of < 35g/l: at risk |
| China | Woo et al. (2005)69 | ≥ 65 years of age | 867 | Hospitals & nursing homes (not specified) | 36 (25.8+10.1) | Chinese Nutrition Screening (CNS) (at risk + malnourished). A questionnaire based on MNA, specifically orientated to Chinese elderly in hospitals and nursing homes. 16 questions regarding lifestyle, health and dietary care tailored to suit Chinese healthcare system, diet, culture and customs. It omits anthropometry and has a maximum score of 32. The higher the score, the better the nutrition status. Further detail unavailable |
| China | Zhang et al. (2020)70 | ≥ 65 years of age | 182 | Hospital (not specified) | 80.2 (27.5+52.7) | MNA (at risk + malnourished) |
| India | Karmakar et al. (2010)71 | > 60 years of age | 76 | Hospital – tertiary, inpatients and outpatients (not specified) | 27.6 (of which 61.9) 42.1 (of which 57.1) | BMI undernourished < 18.5 kg/m2 (severely dernourished < 16 kg/m2) IBW undernourished < 85% (severely undernourished < 70%) |
| MIDDLE EAST | ||||||
| Israel | German et al. (2008)72 | ≥ 65 years of age | 195 | Hospital (within 24 hours of admission) | 39 | MNA (no further details given) |
| AUSTRALIA & NEW ZEALAND | ||||||
| Australia | Vivanti et al. (2011)73 | Older people | 194 | Hospital – geriatric assessment and rehabilitation unit (within 72 hours of admission) | 39 (35.1+3.6) | SGA (moderate + severe) |
| Australia | Adams et al. (2008)74 | ≥ 70 years of age | 100 | Hospital – tertiary (within 24–48 hours of admission) | 91 (61+30) | MNA (at risk + malnourished) |
Table A1.3
Prevalence of malnutrition or risk of malnutrition in some examples of studies reported after 2002 according to country and healthcare setting – outpatients
| Country | Author (year) | Study population | Patients (n) | Healthcare setting † | Prevalence % (risk category) | Method and details of risk category where reported |
|---|---|---|---|---|---|---|
| EUROPE | ||||||
| Italy | Bozzetti (2009)75 | Adults with cancer | 1000 | Outpatients | 33.8, 39.7 | NRS-2002 (score ≥ 3 = malnourished). Significant weight loss (≥ 10%) |
| The Netherlands | Leistra et al. (2009)76 | > 18 years of age | 2288 | General outpatient departments in 9 hospitals | 7.1 (2 + 5.1) Wide variation depending on type of department | Moderate malnutrition = BMI ≥18.5 kg/m2 with 5–10% unintentional weight loss in the last 6 months. Severe malnutrition = one or more of the following present: BMI < 18.5 kg/m2 and/or intentional weight loss of > 5% in the last 1 month or > 10% in the last 6 months |
| The Netherlands | Neelemaat et al. (2008)77 | Adults aged > 18 years | 705, 979 | General outpatients, Preoperative outpatients | 12 (7 + 5), 17 (9 + 8) | SNAQ. 3 questions: ‘Did you lose weight unintentionally (> 6 kg in the last 6 months and/or > 3 kg in the last 1 month)? Did you use supplemental drinks or tube feeding over the last month? Did you experience difficulties when eating and drinking over the last month? (moderate = score of ≥ 2 and severe = score of ≥ 3) |
| The Netherlands | Vermeeren et al. (2006)78 | Adults aged 40–75 years with COPD | 389 | Outpatients in 39 centres | 27 | Nutritional depletion defined as BMI ≤ 21 kg/m2 and or Fat-Free Mass Index (FFMI) ≤ 15 kg/m2 (females) or ≤ 16 kg/m2 (males) |
| Turkey | Ozer et al. (2022)79 | Older people aged ≥ 60 years | 252 | Outpatients | 32.212.713.1 | GLIM criteriaMNA-LFMNA-SF |
| Turkey | Halil (2009)80 | Older people aged ≥ 65 years | 2327 | Geriatric medicine outpatient clinic | 28 | MNA-SF. Malnutrition risk = MNA ≤11 points |
| UK | Collins et al. (2010)81 | Adults with COPD | 425 | Outpatients (overall) Mild disease, Moderate disease, Severe disease | 21 (7 + 14)131226 | ‘MUST’ (medium + high risk) |
| UK | Rust et al. (2010)82 | Adults | 321 | General hospital outpatients | 15.9 (10.9 + 5) | ‘MUST’ (medium + high risk) |
| UK | Renshaw et al. (2008)83 | Adults with cancer | 207 | Medical oncology outpatients | 83 (upper GI)76 (lung/ mesothelioma)73 (gynaecological)60 (breast)
50 (colorectal) 45 (urological) |
Nutritional risk determined using local trust validated Nutrition Screening Tool (includes questions on unintentional weight loss, appetite reduction in previous 3–6 months, height, usual and current weight and BMI). Details of validation not given |
| UK | Stratton et al. (2004)84 | Adults | 50 | Gastroenterology outpatients | 30 (18 + 12) | ‘MUST’ (medium + high risk) |
| UK | Sze et al. (2019)85 | Adults with chronic heart failure | 1058 | Community clinic | 14 | Geriatric Nutritional Risk Index |
†Timing not specified in studies; assume on attendance during the period of the study
Table A1.4
Prevalence of malnutrition or risk of malnutrition in some examples of studies reported after 2002 according to country and healthcare setting – care homes (majority of participants were older people)
| Country | Author (year) | Study population | Patients (n) | Healthcare setting (and timing of nutritional screening/assessment) | Prevalence % (risk category) | Method and details of risk category where reported |
|---|---|---|---|---|---|---|
| EUROPE | ||||||
| Austria | van Nie-Visser et al. (2009)86 | Residents of care homes (age not reported) | 221 | Care homes (on admission) | 28 | Malnutrition prevalence measured by assessing BMI, undesired weight loss and nutritional intake (no further details given) |
| Belgium | Vandewoude et al. (2018)87 | ≥ 70 years of age | 3299 | Community dwelling and nursing homes | 124463 | MNA-SF (malnourished score < 8) MNA-SF (at risk score 8–11). Malnutrition (including risk of) observed in nursing homes alone |
| Denmark | Beck & Ovesen (2002)88 | > 65 years of age | 180 | Nursing homes (not specified) | 33 (22) | BMI < 20 kg/m2 (BMI < 18.5 kg/m2) |
| Finland | Suominen et al. (2009)89 | Older people | 1043 | Long-term elderly care facilities (all patients during 2 weeks in September 2003) | 97.4 (40.7+56.7), 15.2 | At risk MNA 17–23.5 points, malnourished MNA < 17 points. Nurse assessment using BMI |
| France | Bourdel-Marchasson et al. (2009)90 | Older people | 517 | Nursing Homes† (random sample of 15 residents from each home at the time of the interview visit) | 54.9 (13.1) | At risk MNA-SF score ≤ 11 (of whom malnourished MNA score < 17) |
| France | Bourdel-Marchasson et al. (2009)90 | Older people | 84 | Long-term care homes† (random sample of 15 residents from each home at the time of the interview visit) | 90.4 (42.9) | At risk MNA-SF score ≤ 11 (of whom malnourished MNA score < 17) |
| Germany | Volkert et al. (2011)91 | > 65 years of age | 350 | Nursing home (not specified) | 79.6 (52.9+26.7) | MNA ( at risk + malnourished ) |
| Germany | Smoliner et al. (2009)92 | Older people | 114 | Nursing home (not specified) | 80.7 (57.9+22.8) | At risk MNA 17–23.5 points, malnourished < 17 points |
| Germany | van Nie-Visser et al. (2009)86 | Residents of care homes (age not reported) | 2444 | Care homes (on admission) | 26 | Malnutrition prevalence measured by assessing BMI, undesired weight loss and nutritional intake (no further details given) |
| Germany & Austria | Valentini et al. (2009)93 | > 50 years age | 2137 | Nursing homes (one-day cross- sectional audit on 22nd February 2007) | 16.7 (13.9)9.2 (14.3) | Malnourished : BMI < 20 kg/m2 (at risk of malnutrition : BMI 20–21.9 kg/m2)Subjectively assessed by staff. (Malnourished (at risk of malnutrition) |
| Germany | Norman et al. (2007)94 | Age range 79.1–91.4 years | 112 | Nursing home (not specified) | 80.3 (71.4+8.9) | MNA ( at risk + malnourished ) |
| Hungary | Lelovics et al. (2009)95 | Older people > 60 years | 1381 | Nursing homes (unclear) | 38.1 (8.0+30.1) | ‘MUST’ ( medium + high ) |
| Italy | Santomauro et al. (2011)96 | ≥ 65 years of age | 463 | Nursing homes | 80.8 (58.3+22.5) | MNA ( at risk + malnourished ) |
| Italy | Cereda et al. (2009)97 | Older people | 241 | Long-term care for older people (not specified) | 51.8 (39+12.8)56.8 (36.1+20.7) | At risk MNA 17–23.5 points, malnourished < 17 points.GNRI moderate risk : GNRI 92–98, high risk : GNRI < 92 |
| Italy | Pezzana et al. (2009)98 | Older people | 738 | Nursing homes (not specified) | 78 | MNA-SF (no further details given) |
| Portugal | Madeira et al. (2019)99 | ≥ 65 years of age | 1186 | Nursing homes | 43.5 (38.7+4.8) | MNA ( at risk + malnourished ) |
| Republic of Ireland | Russell & Elia (2012)15 spring (2011) | > 18 years of age* | 29 (Note: only 6 homes took part) | Care homes (overall). Nursing homes only. Residential homes only. Other homes (restricted to adults admitted within the previous 6 months) | 21 (7+14)**25020 | ‘MUST’ ( medium + high ) |
| Republic of Ireland | Russell & Elia (2011)16 (winter 2010) | > 18 years of age* | 153 | Care homes (overall). Nursing homes only. Residential homes only. Other homes (restricted to adults admitted within the | 32 (16 + 16)** (n = 143) 34 9
32 |
‘MUST’ (medium + high) |
| previous 6 months) | 32 (16+16), 34 , 9 , 32 | ‘MUST’ ( medium + high ) | ||||
| Spain | Ruiz-Lopez et al. (2003)100 | Women aged 72–98 years | 89 | Nursing homes – private | 69.7 (61.8+7.9) | MNA ( at risk + malnourished ) |
| Sweden | Westergren et al. (2008)22 | All residents* | 1726 | Special accommodation –nursing home-type setting (not specified) | 27 | At risk of under-nutrition if 2–3 of the following 3 criteria fulfilled: (1) involuntary weight loss (irrespective of time and amount), (2) BMI below limit (< 20 kg/m2 if ≤ 69 years, < 22 kg/m2 if ≥ 70 years), and (3) the presence of eating difficulties. Low risk: 1 criterion fulfilled, moderate risk: 2 criteria fulfilled, high risk: 3 criteria fulfilled. Not reported separately |
| The Netherlands | Meijers et al. (2009)27 | ≥ 18 years of age* | 2061 | Nursing homes (cross-sectional, point prevalence on specified days) | 19.2 | Malnutrition defined according to one of the 3 following criteria: (1) BMI < 18.5 kg/m2 (2) unintentional weight loss (6 kg in previous 6 months or 3 kg in previous month) or (3) BMI 18.5–20 kg/m2 in combination with no nutritional intake for 3 days or reduced intake for > 10 days |
| The Netherlands | van Nie-Visser et al. (2009)86 | Residents of care homes (age not reported) | 583 | Care homes (on admission) | 27 | Malnutrition prevalence measured by assessing BMI, undesired weight loss and nutritional intake (no further details given) |
| The Netherlands | Kruizenga et al. (2003)29 | > 18 years of age* | 808 | Nursing homes (convenience sample, timing not clear) | 18 (12+6) | At risk of malnutrition: 5–10% unintentional weight loss during the past 6 months, malnourished: unintentional weight loss > 10% during the past 6 months |
| The Netherlands | Everink et al. (2021)101 | Residents of nursing homes (age not reported) ) | 14317 | Nursing homes (secondary analysis of the International Prevalence Measurement of Care Quality study) | 16.7 | Criteria to assess malnutrition:
ESPEN definition. A person suffers from malnutrition if:
|
| Turkey | Basibüyük et al. (2019)102 | > 60 years of age | 773 | Nursing homes (residing at nursing homes for at least six months) | 45.4 (37+8.4) | MNA-SF ( at risk + malnourished ) |
| UK | Parsons et al. (2010)103 | Residents of care homes* | 1176 | Care homes – overall (not specified) | 39 (14+25) | ‘MUST’ ( medium + high ) |
| UK | Parsons et al. (2009)104 | Residents of care homes* | 1176 | Nursing homes, Residential homes (cross-sectional survey) | 40 , 36 | ‘MUST’ ( medium + high ) |
| UK | Russell & Elia (2012)15 | Adults ≥ 18 years of age* | 523 | Care homes (overall) Nursing homes only Elderly mentally ill homes only Residential homes only Other homes (restricted to adults admitted within the previous 6 months) | 41 (16+25)**464041
39 |
‘MUST’ ( medium + high ) |
| UK | Russell & Elia (2011)16 | Adults ≥ 18 years of age* | 821 | Care homes (overall) Nursing homes only Elderly mentally ill homes only Residential homes only Other homes (n = 815) (restricted to adults admitted within the previous 6 months) | 37 (15+23)**452630
36 |
‘MUST’ ( medium + high ) |
| UK | Russell & Elia (2009)32 | > 18 years of age* | 614 | Care homes (overall) Nursing homes only Elderly mentally ill homes only Residential homes only Other homes (n = 581) (restricted to adults admitted within the previous 6 months) | 42 (11+30)**465936
43 |
‘MUST’ ( medium + high ) |
| UK | Russell & Elia (2008)33 | > 18 years of age* | 1610 | Care homes (overall) Nursing homes only Residential homes only Other homes (restricted to adults admitted within the previous 6 months) | 30 (10+20)352232 | ‘MUST’ ( medium + high ) |
| UK | Elia & Stratton (2005)105 | > 65 years of age | 202 | Institution (secondary analysis of the National Diet and Nutrition Survey) | 20.8 (8.9+11.9) | ‘MUST’ type criteria applied, i.e. a score of current weight status added to the weight loss score ( medium + high ) |
| ASIA | ||||||
| China | Woo et al. (2005)69 | ≥ 65 years of age | 867 | Nursing homes & hospitals (not specified) | 36 (25.8+10.1) | CNS ( at risk + malnourished ). A questionnaire based on MNA, specifically orientated to Chinese elderly in nursing homes and hospitals. 16 questions regarding lifestyle, health and dietary care tailored to suit Chinese health care system, diet, culture and customs. It omits anthropometry and has a maximum score of 32. The higher the score, the better the nutrition status. Further details unavailable |
| Singapore | Chan et al. (2010)106 | Older people | 154 | Nursing homes – voluntary welfare (not specified) | 529739 | BMI – underweight < 18.5 kg/m²MNA-SF ( at risk )MNA ( malnourished score < 17) |
| Taiwan | Chang & Roberts (2011)107 | ≥ 60 years of age with dementia | 83 | Nursing homes >15 residents with dementia (not specified) | 90.419 | MNA-SFBMI (<18.5 kg/m²) |
| MIDDLE EAST | ||||||
| Saudi Arabia | Alhamdan (2004)108 | Adult males < 60 years of age. Elderly males ≥ 60 years of age | 39, 45 | Nursing homes (not specified) | 12.811.1 | BMI – underweight <18.5 kg/m² |
| AUSTRALIA & NEW ZEALAND | ||||||
| Australia | Grieger et al. (2009)109 | Aged care residents | 74 | High-level care nursing homes & low-level care hostels | 53 (37+16) | MNA ( at risk + malnourished ) |
| Australia | Gaskill et al. (2008)110 | Older people | 346 | Residential aged care facilities (6-week period, late 2005) | 49.5 (43.1 + 6.4) (range 72.1–31.8% across 8 facilities) | SGA ( moderate + severe ) |
| Australia | Banks et al. (2007)51 | Older people | 381 (2002), 458 (2003) | Residential aged care facilities (a single day for each facility 2002 + 2003) | 50.0 (41.6+8.4)49.2 (41.6+8.4) | Median MNA ( moderate + severe )Median MNA ( moderate + severe ) |
†In France, long-term care homes receive older people with functional impairment and severe disease requiring continuous medical care; in contrast, nursing homes do not provide continuous presence of nurses
*Participants’ age in years mean (±SD): special accommodation 85.4 (±7.7),22 nursing homes 80.3 (±10.0),27 nursing homes well-nourished 80 (±11), at risk 81 (±11), malnourished 83 (±9),29 care homes 86.5 (±8.7),103;104 UK care homes 83.3 (±9.5),32 84.2 (±8.4),33 83.1 (±9.7),16 80.4 (±11.8)15. Republic of Ireland care homes 80.8 (±9.3),16 83.5 (±7.0)15
** Figures rounded to the nearest 1%
Table A1.5
Prevalence of malnutrition or risk of malnutrition in some examples of studies reported after 2002 according to country and healthcare setting – sheltered accommodation (majority of participants were older people)
| Country | Author (year) | Study population | Patients (n) | Healthcare setting (and timing of nutritional screening/assessment) | Prevalence % (risk category) | Method and details of risk category where reported |
|---|---|---|---|---|---|---|
| EUROPE | ||||||
| Finland | Vikstedt et al. (2011)111 | > 60 years of age | 375 | Serviced housing (not specified) | 86 (21 + 65) | MNA |
| Sweden | Odlund Olin et al. (2008)112 | Frail older people | 49 | Serviced flats (before and after intervention with additional meal) | 90 (27 + 63) (baseline) | MNA (malnourished: score < 17 + at risk of malnutrition score: 17–23.5) |
| Sweden | Ödlund Olin et al. (2005)113 | Elderly 68– 96 years of age | 80 | Serviced flats (not specified) | 89 (59 + 30) | MNA (at risk + malnourished) |
| UK | Ralph et al. (2010)114 | Individuals in sheltered housing* | 1353 | Sheltered housing schemes (overall) > 80 years of age < 80 years of age (individuals screened during invited coffee mornings over 6-month period) | 12 (7 + 5) 14 9 |
‘MUST’ (medium + high) |
| UK | Elia & Russell (2009)115 | Older people | 335 | Sheltered accommodation (not specified) | 14 (5 + 9) | ‘MUST’ (medium + high) |
| UK | Harris et al. (2007)116 | > 65 years of age | 100 | Sheltered accommodation (not specified) | 10 12 17 |
Dietitian assessment ‘MUST’ (medium + high risk). Not reported separately MNA (screening score < 12) |
Table A1.6
Prevalence of malnutrition or risk of malnutrition in some examples of studies reported after 2002 according to country and healthcare setting – free-living (majority of participants were older people)
| Country | Author (year) | Study population | Patients (n) | Healthcare setting (and timing of nutritional screening/assessment) | Prevalence % (risk category) | Method and details of risk category where reported |
|---|---|---|---|---|---|---|
| EUROPE | ||||||
| Denmark | Beck & Ovesen (2002)88 | > 65 years of age | 200 | Home care districts (not specified) | 30 (12) | BMI <20 kg/m² (BMI < 18.5 kg/m²) |
| France | Sánchez-Rodríguez et al. (2019)117 | ≥ 75 years of age | 179 | Community-dwelling (not specified) | 7.3 | ESPEN diagnostic criteria for malnutrition (2015). Step 1: identification of subjects at nutritional risk Step 2: BMI (< 18.5 kg/m² indicating malnutrition) OR unintended body weight loss (>5% within the last 3 months or >10% within an unspecified time frame) combined with BMI (< 20 kg/m² for subjects < 70 years and < 22 kg/m² for subjects > 70 years) or fat-free mass index (FFMI) (<17 kg/ m² in men and <15 kg/ m² in women). |
| Republic of Ireland | O’Dwyer et al. (2009)118 | Older people | 63 | Meals on wheels recipients (not specified) | 36.5 (27+9.5) | At risk MNA 17–23.5, malnourished MNA < 17 |
| Sardinia | Buffa et al. (2010)119 | ≥ 70 years of age** | 170 | Free-living (not specified, in 2005) | 37.1 (35.9+1.2) | MNA ( at risk + malnourished ) |
| Spain | de la Montana & Miguez (2011)120 | > 65 years of age | 728 | Home-living | 59 (46.7+12.4) 70.1 (57.6+12.5) |
MNA-SF ( at risk + malnourished ) MNA ( at risk + malnourished ) |
| Spain | Rodríguez-Sánchez et al. (2020)121 | ≥ 65 years of age | 1660 | Institutionalised (2%) or community-dwelling (98%) | 27.6 (15+12.6) | GLIM criteria (at risk + malnourished) |
| Spain | Cuervo et al. (2008)122 | > 65 years of age | 22007 | Community-dwelling (cross-sectional survey) | 29.7 (25.4+4.3) | At risk MNA ≥ 17 to ≤ 23.5, malnourished MNA < 17 |
| Sweden | Johansson et al. (2009)123 | Older people | 579 | Home-living Baseline At follow-up 1–4 (between 2001 & 2006 (prospective study, assessed at baseline & follow-up as above) |
14.5 7.6–16.2 |
At risk MNA 17–23.5, malnourished MNA < 17 |
| The Netherlands | Meijers et al. (2009)27 | ≥ 18 years of age* | 2794 | Home care (cross-sectional, point prevalence) | 21.7 | Malnutrition defined according to one of the 3 following criteria: (1) BMI < 18.5 kg/m2 (2) unintentional weight loss (6 kg in previous 6 months or 3 kg in previous month) or (3) BMI 18.5–20 kg/m2 in combination with no nutritional intake for 3 days or reduced intake for > 10 days |
| The Netherlands | Kruizenga et al. (2003)29 | > 18 years of age* | 533 | Home care (convenience sample, timing not clear) | 13 (7+6) | At risk of malnutrition: 5–10% unintentional weight loss during the past 6 months, malnourished: unintentional weight loss > 10% during the past 6 months |
| UK | Skinner et al. (2010)124 | Older people | 111 | Meals on wheels recipients (not specified) | 31 (16+15) | ‘MUST’ ( medium + high ) |
| UK | Elia & Stratton (2005)105 | > 65 years of age | 953 | Free-living (secondary analysis of the National Diet and Nutrition Survey) | 12.5 (6.6+5.9) | ‘MUST’ type criteria applied, i.e. a score of current weight status added to the weight loss score ( medium + high ) |
| USA & CANADA | ||||||
| USA | Fodero & Wunderlich (2008)125 | ≥ 60 years of age | 34 | Convenience sample enrolled on Congregate Dining Programme and tai chi classes (not specified) | 5.9 (5.9+0) | MNA ( at risk + malnourished ) |
| CENTRAL & SOUTH AMERICA | ||||||
| Brazil | De Andrade et al. (2009)126 | > 60 years | 834 | Non-institutionalised – participating in Family Health Programme & Community Agents Health Programme (not specified) | 2.1 | BMI ( underweight < 18.5 kg/m²) |
| Cuba | Da Silva Coqueiro et al. (2010)127 | ≥ 60 years of age | 1688 | (Data from Survey on Health, Aging and Well-being of the Elderly SABE 2000) | 33 | BMI ( underweight <22 kg/m²) |
| ASIA | ||||||
| China | Han et al. (2008)128 | ≥ 65 years of age | 162 | Community-dwelling (convenience sample, Jul-Sep 2007) | 44.4 (36.4+8.0) | MNA ( at risk + undernourished ) |
| Japan | Iizaka et al. (2008)129 | ≥ 65 years of age | 130 (missing data n = 3) | Attendees of Setagya Senior College (November–December 2006) | 12.6 (12.6+0) | MNA ( at risk + undernourished ) |
| Taiwan | Tsai et al. (2010)130 | ≥ 65 years of age | 2802 (1534 male, 1268 female) | Free-living(data from ‘Survey of Health and Living Status of the Elderly in Taiwan’ SHLSET) | 18 (15.1 + 2.9)male 24 (21.2 + 2.8) female 14.3 (12.0 + 2.3) male
14.3 (12.3 + 2.0) male |
MNA (at risk + malnourished)MNA-Taiwan version-1 (MNA-T1) (at risk + malnourished). Modified version of MNA altering the questions on protein intake to emphasise the frequency of consumption rather than the number of servings. Also contains Taiwanese- specific anthropometric cut-offs (no details given)
MNA-Taiwan version-2 (MNA-T2) (at risk + malnourished). Modified version of MNA with questions relating to protein intake as MNA-T1. Also, the BMI question omitted and redistributed BMI score to MAC – 1 point and calf circumference (CC) – 2 points |
| Taiwan | Tsai et al. (2008) 131 | ≥ 65 years of age | 2400 | In-home interviews, part of population- based “The Survey of Health & Living Status of the Elderly in Taiwan” (not specified) | 15.1 (13.1 + 2.0) | MNA ( at risk + undernourished ) |
| AUSTRALIA & NEW ZEALAND | ||||||
| Australia | Leggo et al. (2008)132 | Older people requiring help with daily tasks and younger people with impaired functional ability | 1145 | Home and Community Care recipients (not specified September 2003 – June 2005) |
15 | MST. The MST was modified with an additional question ‘client appears very underweight or frail’, with ‘yes’ recommending dietetic referral, score 0–1 indicates low risk , 2 at risk , 3–4 higher level of risk , 5 very high risk of malnutrition |
| Australia | Visvanathan et al. (2003)133 | ≥ 65 years of age | 250 | Domiciliary care service recipients (between January and December 2000) | 43.0 (38.4+4.8) | MNA ( at risk + malnourished ) |
| New Zealand | Teh et al. (2010)134 | 75–79 years of age (Maori) 85 years of age (non-Maori) | 108 | Free-living (not specified January – August 2008) |
52 | Seniors in the Community: Risk evaluation for Eating and Nutrition Version II (SCREEN II). Weight change, food intake, risk factors for food intake (meal frequency, diet restriction, appetite, chewing and swallowing difficulties, meal replacement, eating alone, meal preparation, shopping difficulties). Each item scores 0–4, lower scores indicating problems indicating nutrition risk. Total scores 0–64, < 50 = at significant nutrition risk |
| New Zealand | Wham et al. (2011)135 | 80–85 years of age | 51 | Free-living (convenience sample April – July 2006) | 31 | SCREEN II <50 score = at significant nutrition risk |
*Participants’ age in years mean (±SD): home care 76.2 (±12.0),27 home care well-nourished 59 (±20), at risk 64 (±23), malnourished 66 (±23)29
**Age ranges of sample: 70–79 years n = 103, 80–89 years n = 66, 90+ years n = 31
Table A1.7
Prevalence of malnutrition or risk of malnutrition in some examples of studies reported after 2002 according to country and healthcare setting – other care settings
| Country | Author (year) | Study population | Patients (n) | Healthcare setting (and timing of nutritional screening/assessment) | Prevalence % (risk category) | Method and details of risk category where reported |
|---|---|---|---|---|---|---|
| EUROPE | ||||||
| The Netherlands | Poels et al. (2006)136 | Stroke patients > 18 years of age* | 69 | Stroke rehabilitation centre (on admission) | 35 (primary criteria), 73 (if malnutrition defined by the presence of at least one of the primary or secondary criteria) | Malnutrition assessed by a dietitian. Primary criteria for malnutrition were unintentional weight loss of > 5% in 1 month or > 10% in 6 months or a BMI < 18 kg/m2 (< 65 years) or < 22 kg/m2 (≥ 65 years). Secondary criteria for malnutrition: (1) serum albumin < 25 g/l, (2) Free-fat Mass (FFM) ≤ 16 kg/m2 (men), ≤ 15 kg/m2 (women), (3) TSFT < 90% of 12.5 mm (men) or 16.5 mm (women), (4) MAMC < 90% of 25.3 cm (men) or 23.3 cm (women) |
| UK | Russell & Elia (2012)15 (spring 2011) | Adults ≥ 18 years of age* | 543 | Mental health units (Acute units within 72 hours of admission, long-stay/rehab units within previous 6 months) | 19 (9+10) | ‘MUST’ (medium + high) |
| UK | Russell & Elia (2011)16 (winter 2010) | Adults ≥ 18 years of age* | 146 | Mental health units (Acute units within 72 hours of admission, long-stay/rehab units within previous 6 months) | 18 (12+7)** | ‘MUST’ ( medium + high ) |
| UK | Russell & Elia (2009)32 | Adults ≥ 18 years of age* | 185 | Mental health units (Acute units within 72 hours of admission, long-stay/rehab units within previous 6 months) | 20 (5+15) | ‘MUST’ ( medium + high ) |
| UK | Russell & Elia (2008)33 | Adults ≥ 18 years of age* | 332 | Mental health units (Acute units within 72 hours of admission, long-stay/rehab units within previous 6 months) | 19 (7+12) | ‘MUST’ ( medium + high ) |
| ASIA | ||||||
| China | Chai et al. (2008)137 | Adults with history of stroke, mean age 76 years | 61 | Cheshire Home Infirmary (not specified) | 8.2 | BMI < 18.5 kg/m² + serum albumin <35 g/l |
| Taiwan | Tsai et al. (2011)138 | Adults with schizophrenia, bipolar disorder, major depression | 120 | Mental health units (convenience sample, not specified) | 21.1 (11.5+9.6) 12.5 (12.5+0) 55.6 (50.0+5.6) |
MNA-Taiwan version 1 (MNA-T1) ( at risk + malnourished ). Content-equivalent version of MNA. MNA-T1 adopted Taiwanese-specific anthropometric cut-off points. For Item G ‘can live independently’, those psychiatrically stable individuals who could carry out daily activities were considered to live independently and given one point in the study |
| MIDDLE EAST | ||||||
| Iran | Amirkalali et al. (2010)139 | ≥ 65 years of age | 221 | Kahrizak Charity Foundation† (not specified) | 46.6 (43.4+3.2) | MNA ( at risk + malnourished ) |
*Participants’ age in years mean (±SD): stroke rehabilitation centre 56.7 (±11.0),138 mental health units 59.2 (±20.0),33 66.4 (±20.1),32 50.0 (±19.0),16 55.9 (±21.6)15
**Figures do not add up due to rounding
†Private non-governmental non-profit charitable organisation where physically handicapped or elderly with no financial resources are cared for free of charge
Table A1.8
Prevalence of malnutrition or risk of malnutrition in children in hospital in studies reported after 2000 according to country
| Country | Author (year) | Study population | Patients (n) | Healthcare setting (and timing of nutritional screening /assessment) ) | Prevalence % (risk category) | Method and details of risk category where reported | ||
|---|---|---|---|---|---|---|---|---|
| Acute | Chronic | Overall | ||||||
| EUROPE | ||||||||
| Austria | Wildham et al. (2007)140 | Children 3–18 years | 100 | Hospital (admission) |
3% (2+1) 18% (13+5) |
17% (8+9) | 15% (15+0) |
Waterlow Score (stunting)**: moderate + severe Waterlow Score (wasting)*: moderate + severe Gomez score (WFA)†: moderate + severe Vienna score (moderate + severe): Based on albumin, total lymphocyte count, haemoglobin measures (see Wildham et al. 2007 for cut-off points), total weight loss of > 5% relative to pre-illness body weight (4 weeks), weight/height centile < 10th centile and lack of appetite. |
| France | Lambe et al. (2010)141 | All children admitted to paediatric neurology and orthopaedic surgery wards with length of stay > 2 days | 348 | Tertiary care paediatric hospital (Timing of assessment not specified) |
4.9% (4+0.9) 2.3% (1.4+0.9) 20% |
Orthopaedic surgery: moderate + severe Neurology: moderate + severe All: mild, moderate + severe for both specialities. Data collection (weight, height, growth charts, clinical history) performed by a dietitian. Nutritional status assessed by a specialist paediatrician. No details given regarding cut-off points for mild, moderate or severe protein-energy malnutrition. |
||
| France | Marteletti et al. (2005)142 | Children aged between 2 months & 16 years hospitalised for > 48 hours | 280 (No age breakdown) |
One-day cross-sectional study over 3 different seasons | 11% | Malnourished: WFH z-score < -2 SD. | ||
| France | Hankard et al. (2001)143 | Children aged > 6 months admitted to medical or surgical wards for > 48 hours | 58 (No age breakdown) |
One-day cross-sectional |
21% 12% |
Malnourished: BMI below -2 SD (when patients with anorexia nervosa excluded).
Note: Patients receiving nutritional support (parenteral, enteral or special regimens for metabolic diseases) were excluded (represented 19% of total number of patients admitted on the day of the survey). |
||
| France | Sermet-Gaudelus et al. (2000)144 | Children aged > 1 month with a hospital stay of ≥ 48 hours admitted to medical or surgical wards |
296 total: • 1–12 mo (n = 133) • 12–72 mo (n = 87) • > 72 mo (n = 76) |
Hospital (within 48h of admission) |
26% 85.2% (40.9+44.3) (No age breakdown) |
Undernourished: percentage IBW < 85%
Simple Paediatric Nutritional Risk Score: Takes account of food intake, pain and pathology. Maximum score 5. Note: Children with conditions that involved large variations in hydration were excluded. |
||
| Germany | Pawellek et al. (2008)145 | All children admitted to 1 of 2 general paediatric
wards or 1 surgical ward |
475 (< 1– 17 years)
< 1 year n = 28
2–5 years n = 164 6–12 years n = 186 13–17 years n = 97 |
Hospital (admission) | 6.1% (4.4+1.7) | 14.2% (7.1+7.1)
4.3% (4.3+0.0) 5.9% (4.8+1.1) 7.2% (3.1+4.1) |
17.2% (7.5+9.7) |
Waterlow criteria:
Mild malnutrition: 81–90% centile WFH TSFT: |
| Italy | Campanozzi et al. (2009)146 | All children aged 1 month to 16 years admitted to medical paediatric ward with ±Grade 1 conditions | 496
1-12 months n = 174 13-24 months n = 72 25-36 months n = 48 37-72 months n = 84 > 72 months n = 118 |
Hospital admission | 10.2
No age breakdown |
Malnourished: BMI z-score < -2
±Grade 1 conditions involve mild stress factors, e.g. admissions for diagnostic procedures, minor infection, other episodic illnesses or minor surgery (American Academy of Pediatrics and American Dietetic Association criteria) Patients with < 72-hour hospital stay, patients aged < 1 month, patients with chronic conditions and patients requiring IV fluid/electrolyte therapy or who were dehydrated were excluded |
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| The Netherlands | Hulst et al. (2010)147 | Children aged > 1 month, admission to paediatric ward and expected stay at least 1 day | 424 No age breakdown |
Hospital admission | 62 (54+8) | STRONGkids includes: 1) SGA 2) high risk disease 3) nutritional intake and losses and 4) weight loss or poor weight increase
(moderate + high risk) |
||
| The Netherlands | Joosten et al. (2010)148 | Children aged > 1 month, admission to medium care unit and expected stay at least 1 day | 424
< 1 year 2-5 years 6-12 years 13-17 years |
Hospital admission | 11
14 14 7 10 |
9
6 8 12 11 |
19
18 21 17 19 |
Acute malnutrition: WFH < -2 SD
Chronic malnutrition: HFA < -2 SD Overall malnutrition rate: presence of acute and/or chronic malnutrition |
| Poland | Horvath et al. (2008)149 | Series of unselected children (age not specified) | 96 No age breakdown |
Timing of assessment not specified
Paediatric teaching hospital |
16
14 19 |
Malnutrition was defined as: BMI < 3rd centile for age BMI z-score < -2 SD MAC < 5th centile for age |
||
| Spain | Moreno Villares et al. (2005)150 | Children aged 1 month to 19 years | 268
< 2 years n = 132 2-7 years n = 69 |
17.2 | ||||
| Spain | Villares et al. (2017)151 | Children aged 0 to 17 years | > 7 years n = 62 991 |
Hospital (on admission) | 7.1 (moderate) 0.7 (severe) |
2.7 (moderate) 1.4 (severe) |
11.9 | STAMP |
| Turkey± | Dogan et al. (2005)152 | Children aged 1 month to 23 years No age breakdown |
528 (223 female) | Hospital admission | 52.4 40.9 |
27 | 45.7 | Acute malnutrition: based on WFA based on WFH Chronic malnutrition (based on HFA) |
| Turkey± | Ozturk et al. (2003)153 | Children aged > 1 month to 17 years | 170 | Hospital admission | 30.4 (21.7 + 5.8 + 2.9) | Mild, moderate and severe malnutrition Mild: 80-89% of ideal body WFH Moderate: 70-79% of ideal body WFH Severe: < 70% of ideal body WFH |
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| UK | McCarthy et al. (2012)154 | All children aged 2-17 years admitted to participating medical & surgical wards No age breakdown |
238 | Timing of screening/assessment not reported
Large paediatric hospital |
18
14 |
STAMP. Consists of 3 scored elements: clinical diagnosis, nutritional intake, anthropometric measures. An overall score of ≥ 4 considered as ‘at nutrition risk’
Full nutritional assessment by a RD, consisting of a face-to-face interview to obtain dietary, personal and clinical information from medical and nursing notes |
||
| UK | Gerasimidis et al. (2010)155 | All children aged 1 – 16 years admitted to 4 paediatric wards (Tertiary paediatric hospital [TPH], 3 medical & 1 surgical, District general hospital [DGH] 1 general paediatric) | 247 No age breakdown |
Within 24 hours of hospital admission
District general hospital (DGH) Tertiary paediatric hospital (TPH) |
DGH 19.4 (10.4 + 9) TPH |
PYMS (medium + high risk)
STEP 1: BMI below 2nd centile (-2 SD) on UK 1990 growth chart Low risk of malnutrition: score of 0 Note: Patients from cardiology, renal and orthopaedic specialities, critical care and day assessment were not included |
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| USA & CANADA | ||||||||
| Canada | Groleau & Babakissa (2008)156 | Children aged 0-18 years No age breakdown |
173 | On hospital admission | 79.8
28 35 |
Nutritional paediatric nutrition score published in 2000 (likely to be Sermet-Gaudelus et al. 2000)
Canadian Paediatric Society’s recommendations (no details given) Waterlow score (no details given on whether this was acute or chronic) |
||
| Canada | Secker & Jeejeebhoy (2007)157 | Consecutive children aged 31 days to 17.9 years scheduled for surgery | 175
31 days -2 years n = 51 2-5 years n = 22 5-12 years n = 45 12-17 years n = 57 |
Nutritional assessment undertaken either the day before surgery or the morning of surgery for same-day admissions
Large paediatric academic hospital |
51 (36 + 15)
No age-related breakdown of prevalence |
Subjective Global Nutritional Assessment (SGNA) (moderate + severe)
Note: requiring major abdominal or non-cardiac thoracic surgery on a nonemergency basis and who had not undergone surgery in the 30 days before screening |
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| Canada | Bélanger et al. (2019)158 | Children aged 1 month to 18 years | 307 | Paediatric hospital: medical, surgical, or oncology ward (on admission) | 36.9 (31.3 + 5.6)
86.9 (60.3 + 26.6) 19.5 |
Subjective Global Nutritional Assessment (SGNA) (moderate + severe)
Screening Tool Risk on Nutritional Status and Growth (STRONGkids) (medium and high risk) Malnutrition was defined as a weight-for-age, height-for-age, body mass index-for-age, or weight-for-length/height z score <-2 SD. |
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| CENTRAL & SOUTH AMERICA | ||||||||
| Brazil± | Fernandez et al. (2008)159 | Children aged < 3 years | 67 (46% < 2 years old) | Within 48 hours of admission Hospital general paediatric unit | 43 | Gomez score (WFA)
Categories not reported separately, prevalence reported as ‘had some degree of malnutrition’ |
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| Brazil± | Rocha et al. (2006)160 | Children: average age 21.6 ±15.4 months (62.2% aged < 24 months) | 203
Aged 3-11 months n = 69 12-23 months n = 57 24-59 months n = 77 |
Within 48 hours of admission | 18.7
6.9 |
18.2 | Weight for? age (moderate and/or severe) Weight/stature (moderate and/or severe) Stature for? age (moderate and/or severe) Classified in accordance with WHO criteria: Mild malnutrition: z-score from -1 to -2 SD Moderate malnutrition: z-score from -2 to -3 SD Severe malnutrition: z-score less than -3 SD Ages corrected for children with gestation age < 37 weeks Note: Children with chronic liver or renal disease, surgical pathologies or cerebral palsy or who were admitted to intensive care or oncology units with rehospitalisation during the study period were excluded |
|
| Cuba± | Jimenez et al. (2008)161 | All children (age not specified) No additional data | 162 | On admission Tertiary level national paediatric hospital | 17.3 | Malnutrition: < 3rd centile WFH; National Growth Charts (severe malnutrition) | ||
| MIDDLE EAST | ||||||||
| Iran± | Mahdavi et al. (2009)162 | Consecutive admissions aged 2-12 years | 140 No age breakdown |
Within 3 days of hospitalisation
Paediatric hospital |
70.7
48.5 |
SGA (SGA B/C)
Objective assessment (Waterlow criteria) includes mild, moderate and severe malnutrition Note: Admissions to surgical, inflectional, oncology, ENT and internal medicine wards (gastroenterology, nephrology, respiratory, neurology, cardiology, metabolic disorder) |
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| AFRICA | ||||||||
| South Africa± | Marino et al. (2006)163 | Patients in all medical and surgical wards and in some specialist outpatient clinics | 227
< 12 months 13–60 months Children > 60 months |
Timing of assessment not reported
Hospital |
40/27
27/21 29/14 |
33.5 34 31 31 |
35 | Undernourished defined as ≤ 2 z-scores for following: WFA/WFH and HFA |
| AUSTRALIA & NEW ZEALAND | ||||||||
| Australia | Aurangzeb et al. (2012)164 | Aged > 1 month | 157 | Tertiary paediatric hospital (new admissions during one week in September 2006) | 4.5
2.5 |
8.9 | 47.8 | WFA z-score ≤ -2 WFH z-score ≤ – 2 HFA z-score ≤ -2 NRS (No nutritional risk: 0–3, moderate risk: 4–5 and high risk: ≥ 7) |
*Acute malnutrition Waterlow score (wasting):145 mild: 80–90% WFH; moderate: 70–80% WFH; severe: < 70% WFH
**Chronic malnutrition Waterlow score (stunting):145 mild: 95–87.5% HFA; moderate: 87.5–80% HFA; severe: < 80% HFA.
†Acute malnutrition Gomez score (WFA)146: mild: 75–90% WFA; moderate: 60–74% WFA; severe: < 60% WFA.
¥WHO criteria:147 moderate: symmetrical oedema – no, WFH -3 ≤ SD-score < -2 (70-79%), HFA -3 ≤ SD-score < -2 (85-89%); severe: symmetrical oedema – yes, WFH SD-score < -3 (<70%), HFA
SD-score < -3 (<85%).
±Countries classed as Upper Middle Income Economies see http://data.worldbank.org/about/country-classifications/country-and-lending-groups for more information.