Proceedings of the Nutrition Society (2019), 78, 372–379 doi:10.

1017/S0029665118002628
© The Authors 2018 First published online 3 December 2018
The Nutrition Society Summer Meeting was held at the University of Leeds, UK on 10–12 July 2018

Conference on ‘Getting energy balance right’

Symposium 4: Nutritional epidemiology and risk of chronic disease

Malnutrition in older adults: screening and determinants

Clare A. Corish1,2* and Laura A. Bardon2,3

1
School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Republic of Ireland
2
UCD Institute of Food and Health, University College Dublin, Dublin, Republic of Ireland
3
School of Agriculture and Food Science, University College Dublin, Dublin, Republic of Ireland
Proceedings of the Nutrition Society

Older adults are at risk of protein-energy malnutrition (PEM). PEM detrimentally

impacts on health, cognitive and physical functioning and quality of life. Given these
negative health outcomes in the context of an ageing global population, the Healthy
Diet for a Healthy Life Joint Programming Initiative Malnutrition in the Elderly
(MaNuEL) sought to create a knowledge hub on malnutrition in older adults. This
review summarises the findings related to the screening and determinants of malnutrition.
Based on a scoring system that incorporated validity, parameters used and practicability,
recommendations on setting-specific screening tools for use with older adults were made.
These are: DETERMINE your health checklist for the community, Nutritional Form for
the Elderly for rehabilitation, Short Nutritional Assessment Questionnaire-Residential
Care for residential care and Malnutrition Screening Tool or Mini Nutritional
Assessment-Short Form for hospitals. A meta-analysis was conducted on six longitudinal
studies from MaNuEL partner countries to identify the determinants of malnutrition.
Increasing age, unmarried/separated/divorced status (vs. married but not widowed), diffi-
culties walking 100 m or climbing stairs and hospitalisation in the year prior to baseline
or during follow-up predicted malnutrition. The sex-specific predictors of malnutrition
were explored within The Irish Longitudinal Study of Ageing dataset. For females, cog-
nitive impairment or receiving social support predicted malnutrition. The predictors for
males were falling in the previous 2 years, hospitalisation in the past year and self-
reported difficulties in climbing stairs. Incorporation of these findings into public health
policy and clinical practice would support the early identification and management of
malnutrition.

Malnutrition: Screening: Determinants: Older adults

What is protein-energy malnutrition?

Worldwide, the population is ageing(1). Europe is no
exception; in 2017, 19·4% of the population was aged PEM, often referred to simply as malnutrition, is a con-
65 years or older and this is expected to increase to dition resulting from inadequate intake of energy (kJ)
29·1% by 2080(2). The proportion of those aged 80 and/or protein, or an inability to absorb and/or digest
years and older is expected to more than double from adequate energy and/or protein. PEM has many asso-
5·5% in 2017 to 12·7% by 2050(2). With this ageing popu- ciated physiological and psychological consequences;
lation comes considerable societal challenges, as declin- these include a decline in physical and/or mental func-
ing health status and disease can lead to disability and tionality, which can result in reduced quality of life,
dependence(3). One such challenge is protein-energy mal- poor disease outcomes and more frequent and longer
nutrition (PEM). hospital stays(4,5). Within the developed world, there

Abbreviations: MaNuEL, Malnutrition in the Elderly; PEM, protein-energy malnutrition; TILDA, The Irish Longitudinal Study of Ageing.
*Corresponding author: Clare Corish, email clare.corish@ucd.ie

https://doi.org/10.1017/S0029665118002628 Published online by Cambridge University Press

 Screening and Determinants of malnutrition 373

has been much discussion about how PEM should be aggravates this issue. Despite these concerns, it is generally
defined(6,7). Although a gold-standard definition has yet agreed that approximately 5–10% of community-dwelling
to be agreed among the scientific community(8), the cur- older adults, 50% of those in rehabilitation, 20% in resi-
rent consensus is that PEM can be broadly defined as a dential care and 40% in the hospital are malnourished(11).
state resulting from lack of uptake or intake of nutrition Malnutrition screening tools have a valuable role in iden-
leading to altered body composition (decreased fat free tifying those who are at risk of malnutrition. However, it
mass) and body cell mass leading to diminished physical is imperative that those who are identified as at risk are
and mental function and impaired clinical outcome from referred to a nutritionally qualified healthcare professional
disease(5). Expert bodies have recommended that diag- with the competence to undertake a full nutritional assess-
nostic criteria for PEM are agreed; this would enable ment that incorporates consideration of the aetiology of
comparison of the results of research studies and facili- the diagnosis of malnutrition and the implementation of
tate standardisation of clinical practice(6,7). To comply an appropriate intervention(12). There is clear evidence
with this recommendation, the European Society for that early identification of malnutrition risk followed by
Clinical Nutrition and Metabolism, in 2015, released a timely and appropriate intervention is associated with bet-
consensus statement that specified the minimum criteria ter nutritional care and lower malnutrition incidence(13).
that should be used to identify malnutrition(8). This con-
sensus stated that malnutrition is present in individuals The Malnutrition in the Elderly project
with BMI <18·5 kg/m2, in those with a combination of
Proceedings of the Nutrition Society

The ageing of the European population and its known

weight loss (either >10% of body weight over an indefi-
association with PEM has stimulated research into this
nite period or >5% over 3 months) and low BMI (BMI
topic. The Malnutrition in the Elderly (MaNuEL) pro-
<20 kg/m2 in those under 70 years and <22 kg/m2 in
ject is a Joint Programming Initiative under the A
those over 70 years) and in those with low fat free mass
Healthy Diet for a Healthy Life theme that ran from
index (<15 kg/m2 for women and <17 kg/m2 for
early 2016 until September 2018. The focus of the project
men)(8). Very recently (September 2018) a global consen-
is on PEM in older persons aged 65 years and older and
sus on the criteria to diagnose malnutrition in adults in
the project consortium comprises twenty-two research
clinical settings has been proposed(9,10). This Global
groups from seven countries (Austria, France,
Leadership Initiative on Malnutrition recommends a
Germany, Ireland, Spain, The Netherlands and New
two-step approach to the diagnosis of malnutrition;
Zealand) in addition to a stakeholder advisory board of
firstly, screening for risk of malnutrition and, secondly,
experts in geriatric nutrition, representative of all rele-
assessment for diagnosis and grading the severity of mal-
vant European expert societies. The project had four
nutrition. Non-volitional weight loss, low BMI and
main objectives: to gain knowledge; to strengthen evi-
reduced muscle mass are recommended as phenotypic
dence‐based practice; to build a better research network
criteria and reduced food intake or assimilation, and
and to harmonise research and clinical practice across
inflammation or disease burden are recommended as
Europe. The design and objectives have previously been
aetiologic criteria. To diagnose malnutrition, at least
explained in detail(14) but a brief outline is given below.
one phenotypic criterion and one aetiologic criterion
should be present. Phenotypic metrics to grade severity
into Stage 1 (moderate) and Stage 2 (severe) malnutrition Knowledge gain
are proposed. It is recommended that the aetiologic cri- The MaNuEL project has summarised current knowl-
teria are used to guide intervention and anticipated out- edge through the use of systematic literature reviews
comes. Overlaps with syndromes such as cachexia and and meta-analyses. These also aim to identify knowledge
sarcopenia should be considered and the diagnostic con- gaps where further research needs to be conducted.
struct should be reconsidered every 3–5 years.
Strengthen evidence‐based practice
Prevalence of protein-energy malnutrition in older adults MaNuEL has synthesised current knowledge about the
screening and identification of malnutrition among
Due to discrepancies surrounding the definitions and diag-
older persons in order to make evidence-based recom-
nostic criteria used to identify malnutrition, there has been
mendations on the most appropriate methods for use in
considerable variation in the prevalence of malnutrition
older adults in the different settings in which older adults
reported between and within the hospital, rehabilitation,
live. The project also attempted to identify effective
residential care and community settings. This issue is fur-
nutrition interventions to prevent or reverse malnutri-
ther aggravated by inconsistency in the terminology and
tion. In addition, the work of MaNuEL will contribute
outcomes being measured. Many studies interchangeably
to recommendations on appropriate methods to assess
use the terms ‘malnutrition risk’ and ‘malnutrition’ to
the determinants of malnutrition that will be used to
mean the same thing. Use of a malnutrition screening
highlight important risk factors for malnutrition among
tool will invariably result in higher prevalence as these
different subgroups of older adults.
tools estimate the risk of malnutrition whereas a full
assessment of a patient at risk of malnutrition using diag-
nostic measures of malnutrition will result in a lower Build capacity
prevalence. Moreover, the use of different diagnostic cri- MaNuEL has worked to develop a competent network of
teria and screening tools within each setting further researchers who have a track record of collaboration on

https://doi.org/10.1017/S0029665118002628 Published online by Cambridge University Press

 374 C. A. Corish and L. A. Bardon

the topic of malnutrition in older adults across Europe older person is likely to be different from that of a hospita-
and globally, which will contribute to future collabora- lised older person or an older person who is in long-term
tive projects. residential care. Furthermore, the barriers to nutrition
screening may, certainly in part, relate to their suitability
Harmonise research and clinical practice for use in different settings. It is likely, therefore, that
screening tools should be setting dependent.
The MaNuEL project promotes the harmonisation of
Work package 2 of the MaNuEL project aimed to,
research, policy, education and clinical practice with regard
firstly, create a database and review existing tools used
to malnutrition in older adults. Particular emphasis is
to screen for malnutrition in older adults and, secondly,
being placed on harmonising the screening and assessment
create a scoring system to rate these screening tools and
of malnutrition in older persons in clinical practice with
identify those most appropriate to screen for malnutrition
evidence-based research. Furthermore, harmonisation of
in older adults across all settings (community, hospital,
data collection, databases and data analyses has occurred
rehabilitation, residential care). The review of screening
within the MaNuEL project. Combined, these efforts will
tools identified forty-eight tools which are in use to screen
facilitate future collaboration among partner countries
for malnutrition in older populations, only thirty four of
and optimise ongoing work in the area.
which have been validated for use in this population(15).
Some of these tools have not been designed or are inappro-
Design of the Malnutrition in the Elderly knowledge hub
priate for use among older populations. Furthermore, the
Proceedings of the Nutrition Society

The MaNuEL Knowledge Hub comprised five connected use of a large number of screening tools has led to poor
work packages (Fig. 1): (i) defining malnutrition; (ii) comparability between studies and the wide disparity in
screening for malnutrition; (iii) determinants of malnutri- the reported prevalence rates of malnutrition risk in
tion; (iv) interventions to prevent and treat malnutrition; older adults. Some studies have used screening tools to
and (v) policies and education regarding malnutrition report the prevalence of malnutrition whereas the diagno-
screening and interventions. The final, sixth work pack- sis of malnutrition requires more in-depth assessment as
age focuses on the management of the overall project. highlighted in the Global Leadership Initiative on
The aim of the present paper is to report on the pub- Malnutrition consensus(9,10). The review highlighted that
lished findings that resulted from the compilation of validation studies were predominantly conducted in hos-
existing data with regard to the screening and determi- pital and community settings while validation studies
nants of malnutrition in older adults(15–18). in the rehabilitation and long-term care settings were
lacking(15). In all settings, many studies were poorly
conducted(15).
Malnutrition screening: why is it important and which To create a scoring system to rate malnutrition screen-
tools are most appropriate to use? ing tools, MaNuEL used a consensus panel of project
partners and experts in geriatric malnutrition. The scor-
Malnutrition screening is useful in identifying those ing system has been explained in detail previously(16).
who are malnourished or at risk of malnutrition(15,19). However, a brief description is as follows: the scoring
Screening should be a quick process, conducted using system comprised three equally weighted domains
a tool which has been validated in the population based on the quality of the validation studies published,
in which it is to be used(15,19) and that is easy to admin- the evidence for the parameters used within the tool to
ister. It is important that screening is conducted regularly indicate malnutrition risk in older adults and the practic-
so that the risk of malnutrition can be identified in a ability of the tool. Each domain could score a maximum
timely manner and appropriate interventions implemen- of 15 points, giving an overall maximum score of 45
ted. For older people, the frequency of malnutrition points. Within each domain, different weightings were
screening is dependent on the setting in which they agreed for each question, based on the evidence for
reside. Within the hospital setting, it is recommended their importance in screening for malnutrition in older
that screening takes place on a weekly basis(12). For adults. The scoring system was applied to each of the
older community-dwelling adults (>75 years), the UK forty-eight tools identified within the review.
National Institute for Health and Care Excellence recom- Using the combined score from the three domains,
mends that screening for malnutrition should take place five screening tools were identified which presently
annually in general practitioner surgeries or where there appear to be best to use with older adults across
is a clinical concern(20). community and healthcare settings. The highest scoring
Current recommendations on which screening tool malnutrition screening tools for older adults were(16):
should be used favour a simplistic approach. For example, (i) DETERMINE your health checklist in community-
European Society for Clinical Nutrition and Metabolism dwelling older adults (26 points); (ii) Nutritional Form
recommends the Mini Nutritional Assessment for older for the Elderly for older persons in the rehabilitation
adults in hospital, long-term care and community set- setting (26 points); (iii) Short Nutritional Assessment
tings(12). Such an approach fails to consider the heterogen- Questionnaire-Residential Care for older adults within
eity between these specific sub-groups of older adults with long-term care or residential settings (28 points); (iv)
regard to the aetiology of their frailty status, level of Malnutrition Screening Tool and the Mini Nutritional
dependence and concurrent morbidity. For example, the Assessment-Short Form for hospitalised older adults
aetiology of malnutrition risk in a community-dwelling (both scoring 26 points).

https://doi.org/10.1017/S0029665118002628 Published online by Cambridge University Press

 Screening and Determinants of malnutrition 375
Proceedings of the Nutrition Society

Fig. 1. Structure of the Malnutrition in the Elderly project. WP, work package.

The score within each domain for the different screen- summarised in Table 2. These reviews predominantly
ing tools is presented in Table 1(16). comprise cross-sectional studies, thus emphasising the
All tools scored low for validation, most scored rea- need for high-quality longitudinal studies in older popu-
sonably well for the parameters included within the lations that investigate the broad range of factors which
screening tools and variable results were obtained for could influence the development of malnutrition(36).
the practicability of the tools. Further aspects of apprais- Identification of determinants is vital to enable nutrition
ing malnutrition screening tools are inter-rater and and healthcare strategies to be implemented that could
intra-rater reliability analyses to measure the agreement potentially reduce the incidence of malnutrition in the
of results of screening between two administrators or older population.
by the same administrator at different time points. Work package 3 of the MaNuEL project conducted a
Presently, little evidence exists on the reliability of mal- multi-cohort meta-analysis of longitudinal studies from
nutrition screening tools(16). Such studies are required partner countries. This is the first meta-analysis of its
and if conducted in a standardised and thorough man- kind and, therefore, provides significant progress in iden-
ner, the inclusion of a reliability domain would add tifying the determinants of malnutrition in older
value when scoring malnutrition screening tools. adults(17). This meta-analysis only included studies of
Based on the work of MaNuEL work package 2, it is longitudinal design and removed participants who were
recommended that more screening tools should not be malnourished at baseline; therefore, distinguishing the
developed but that we should concentrate on improving determinants of malnutrition from the associated con-
the evidence for those which already exist(16). sequences of the condition. Six studies suitable for inclu-
sion were identified; namely, ErnSiPP (Nutritional
Situation of Community-dwelling Older Adults in Need
Determinants of malnutrition of Basic Care; Germany(38)), ActiFe (Activity and
Malnutrition is more prevalent in older adults compared Function in the Elderly; Germany(39)), KORA-Age
with their younger counterparts(21). There are many (Cooperative Health Research in the Region of
social, environmental and health-related factors which Augsburg; Germany(40,41)), LASA (The Longitudinal
can contribute to the development of malnutrition in Aging Study Amsterdam, the Netherlands(42)), TILDA
this population group(22). Although there are a plethora (The Irish Longitudinal Study on Ageing; Ireland(43,44))
of studies which have set out to establish the determi- and LiLACS NZ (Life and Living in Advanced Age,
nants of malnutrition in older adults, by and large, a Cohort Study; New Zealand(45)). These datasets
these studies are cross-sectional in design and their ability are representative of the European population. A uni-
to accurately identify those factors which predict and are form definition of malnutrition was applied. All
not solely associated with malnutrition is poor. Hence, studies used similar assessment methods to collect their
the results of these studies are highly heterogeneous(23–30) data(17).
and have done little to clarify accurately the true determi- The inclusion criteria for this study involved partici-
nants or predictors of malnutrition in older people. There pants aged >65 years and free from malnutrition
are only a small number of longitudinal studies that have (defined as BMI <20 kg/m2 or previous unplanned
been conducted among older populations to explore the weight loss) at baseline. Participants provided BMI infor-
factors that can predict malnutrition prior to its develop- mation at baseline and follow-up. The time-span and
ment(31–34). A number of systematic reviews have been amount of unplanned weight loss varied to a small extent
published on this topic in recent years(35–37). These are depending on the original study design: ErnSIPP and

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 376 C. A. Corish and L. A. Bardon

Table 1. Highest scoring malnutrition screening tools within each healthcare setting(16)
Community Rehabilitation Residential Care Hospital
Score DETERMINE NUFFE SNAQRC MNA-SF Version 1/MST

Validation (max 15) 7 6 7 8/8

Parameters (max 15) 11 13 10 12/5
Practicability (max 15) 8 7 11 6/13
Total (max 45) 26 26 28 26/26

DETERMINE, Determine Your Health Checklist; MNA-SF, Mini Nutritional Assessment Short Form; MST, Malnutrition Screening Tool; NUFFE, Nutritional Form for
the Elderly; SNAQRC, Short Nutritional Assessment Questionnaire Residential Care.

Table 2. Published systematic literature reviews on the determinants of malnutrition in older adults
First Author, Year Inclusion criteria Study population Outcome measures Determinants identified Limitations

Tamura et al. Sixteen studies Long-term care Low BMI Depression Low-quality studies
2013(35) Observational residents Weight loss Impaired function included
cohort (MDS weight loss Poor oral intake
Proceedings of the Nutrition Society

Baseline intervention or >5 lb over 3 m)

(1990–2013) Low MNA score
(<17)
Van der Twenty-eight studies Community-dwelling PEM defined as: Strong evidence: Low-quality studies
Pols-Vijlbrief Cross-sectional older adults living in Low appetite Poor appetite included
et al. 2014(36) (n, 18) the developed world Low energy intake Moderate evidence: No gold standard
Longitudinal (n, 10) Weight loss Edentulousness definition of PEM
(after January 2013) (varying cut-offs) Hospitalisation Heterogeneity of BMI
BMI <18·5, <19, Poor SR health cut-offs
<20, <22, <23, Not diabetic
<24 kg/m2
Favoro-Moreira Six studies All settings PEM defined as: BMI Dementia Wide degree of
et al. 2016(37) Prospective cohort <22, <20 kg/m2 Older age heterogeneity among
(after January 2000) Weight loss >5% Frailty (long-term care) variables analysed as
over 1 m/10% over Polypharmacy different questions/
6 m/>5% over 6 m General health decline tools and definitions of
MNA score <23·5 Eating discrepancies malnutrition were used
MNA-SF score <11 Loss of interest in life
ENS classification: Poor appetite
low/medium/high Dysphagia
risk Institutionalisation

ENS, Elderly Nutrition Screening; m, month; MDS, minimum data set; MNA, Mini Nutritional Assessment; PEM, protein-energy malnutrition; SR, self-rated.

ActiFe, >3 kg over the previous 3 months; LASA, >4 kg malnutrition. Although further meta-analyses are war-
over previous 6 months; LiLACS NZ and KORA-Age- ranted to confirm these factors as the true determinants
>5 kg in previous 6 months; TILDA, >4·5 kg over the of malnutrition in older adults, the meta-analysis study
previous year. Those who were deceased or lost to methods are strong; a uniform definition of incident mal-
follow-up were excluded from the analysis. nutrition was applied across all datasets, a wide range of
This meta-analysis identified six determinants of harmonised potential determinants was assessed and a
incident malnutrition; these were increasing age, being standardised protocol for data analysis was implemen-
unmarried/separated/divorced status (vs. married but ted. Furthermore, this meta-analysis included six longitu-
not widowed status), difficulties walking 100 m, difficul- dinal cohorts of older adults from Western populations.
ties climbing a flight of stairs, hospitalisation in the The findings from this meta-analysis should be incorpo-
year prior to baseline and hospitalisation during the rated into strategies to identify older persons vulnerable
follow-up period. Across these six datasets, the determi- to developing malnutrition. This is particularly relevant
nants of malnutrition appear to be predominantly from for determinants which are potentially modifiable (e.g.
the demographic and physical functioning domains. mobility limitations).
Interestingly, disease-related (with the exception of Although datasets were only included in the meta-
hospitalisation), food intake, lifestyle, psychological and analysis if there was a high degree of similarity between
social factors had no association with incidence of mal- their assessment methods and variables of interest, it
nutrition in this meta-analysis. Furthermore, across all should be acknowledged that some differences between
six studies, appetite falls in the year prior to baseline, liv- the cohorts included in the meta-analysis existed. The base-
ing alone, polypharmacy, smoking status and social sup- line characteristics of the study cohorts are displayed in
port consistently showed no association with incident Table 3. The incidence of malnutrition at follow-up ranged

https://doi.org/10.1017/S0029665118002628 Published online by Cambridge University Press

 Screening and Determinants of malnutrition 377

Table 3. Characteristics of each study population(17)

LILACS
ErnSIPP NZ LASA ActiFe TILDA KORA-Age
(n 216) (n 209) (n 1009) (n 791) (n 1841) (n 778)

Follow-up period (y) 1 3 3 3 2 3

Age (y; mean (SD)) 80·4 (8·0) 84·6 (0·5) 74·6 (6·2) 74·1 (5·9) 71·7 (5·0) 75·1 (6·4)
Baseline BMI (kg/m2); 29·4 (6·3) 27·1 (3·6) 27·3 (3·9) 27·6 (4·0) 28·8 (4·3) 28·6 (4·2)
(mean (SD))
% % % % % %
Marital status
Married 44·4 48·6 57·0 69·4 65·8 66·8
Unmarried/divorced/ 6·0 6·3 10·9 10·7 11·7 7·8
separated
Widowed 49·5 45·1 32·1 19·9 22·4 25·4
Education level
Tertiary 8·8 28·4 11·4 13·9 28·4 27·3
Secondary 54·2 57·1 48·4 32·7 35·3 48·2
Primary/none 37·0 14·5 40·2 53·4 36·2 24·6
Proceedings of the Nutrition Society

Living alone 39·4 52·3 37·8 8·9 27·4 30·6

Receiving social support* 99·5 84·2 50·2 0·9 4·4 11·7
Physical activity
High 5·1 40·0 33·6 22·2 32·2 33·4
Moderate 38·0 34·3 33·5 51·9 36·2 32·9
Low 56·9 25·7 32·9 25·9 31·6 33·7
Alcohol consumers 52·3 76·6 79·1 99·3 56·1 85·0
Current smokers 4·2 2·4 17·6 50·1 10·2 4·5
>2 chronic diseases 90·3 96·7 32·0 67·7 26·9 60·9
Polypharmacy (>5 drugs) 76·1 47·5 12·5 20·3 27·7 29·4
Hospitalisation
Before baseline 57·4 29·9 7·2 17·5 14·3 20·2
During follow-up 43·1 40·1 9·0 − 19·1 25·5
Fair/poor SR health 78·8 17·7 33·1 10·6 22·7 27·2
SR pain 69·2 54·0 34·1 9·1 35·9 63·9
Fair/poor appetite 30·6 14·2 11·2 2·7 9·5 6·0
Cognitive impairment 39·5 7·8 7·4 1·5 5·1 18·3
Depressive symptoms 42·6 4·7 12·5 8·4 6·7 12·2
Difficulties walking 100 m 51·4 42·6 13·8 0·4 7·3 13·0
Difficulties climbing stairs 60·2 47·8 28·1 0·4 36·8 16·3
Falls- >1
1y before baseline 47·7 37·3 31·4 36·0 21·8 14·9
During 2y follow-up 34·3 40·7 31·7 33·4 26·3 17·6
Low HGS 46·6 49·8 28·9 17·0 54·0 14·4
(M < 30 kg, F < 20 kg)

HGS, handgrip strength; SR, self-rated; y, year; ErnSiPP, Nutritional Situation of Community-dwelling Older Adults in Need of Basic Care, Germany; LiLACS NZ,
Life and Living in Advanced Age, a Cohort Study, New Zealand; LASA, The Longitudinal Aging Study Amsterdam, the Netherlands; ActiFe, Activity and Function
in the Elderly, Germany; TILDA, The Irish Longitudinal Study on Ageing, Ireland; KORA-Age, Cooperative Health Research in the Region of Augsburg, Germany.
* Receiving help completing any of the following: getting groceries, making a hot meal or doing household chores.

from 4·6% in KORA-Age to 17·2% in the LiLACS NZ are sex-specific. Ireland is no exception to the rest of
cohort (both over a 3-year follow-up). For the majority Europe with an increasing older population. The propor-
of people, the incidence of malnutrition was attributed to tion of the Irish population aged 65 years and older
weight loss irrespective of the cohort. This highlights that is projected to increase from 19% (2016) to 29% by
recent weight loss should form an essential component in 2041(46,47). For the purpose of this analysis, the data
the identification and assessment of malnutrition in older were stratified by sex. Regression models were developed
people and supports the recently published Global to identify the predictors of incident malnutrition from
Leadership Initiative on Malnutrition consensus(9,10). baseline to the 2-year TILDA follow-up. The same inclu-
sion criteria and definition of malnutrition (BMI <20 kg/
m2 and/or weight loss >10% calculated over the 2-year
Sex-specific predictors of incident malnutrition in older follow-up) that was used in the meta-analysis was applied
Irish adults to this work. In summary, the mean age of the TILDA
Further analysis was conducted on the TILDA dataset to sample (n 1841) was 72 years (SD 4·99) at baseline and
investigate whether determinants of incident malnutrition 49·8% were male (n 916). Incident malnutrition was

https://doi.org/10.1017/S0029665118002628 Published online by Cambridge University Press

 378 C. A. Corish and L. A. Bardon

present in 10·7% (10·4% in males, 11% in females, P = by the Federal Office for Agriculture and Food;
0·649) of the participants at 2-year follow-up. As Ireland: Department of Agriculture, Food and the
a group, the independent predictors of incident mal- Marine, and the Health Research Board (grant number
nutrition were being unmarried/divorced/separated, 15/RD/HDHL/MANUEL); Spain: Instituto de Salud
hospitalisation in the year prior to follow-up, difficulties Carlos III and the SENATOR trial (FP7-HEALTH-
walking 100 m and difficulties climbing stairs. Following 2012-305930); The Netherlands: The Netherlands
stratification by sex, hospitalisation in the year prior to Organisation for Health Research and Development.
follow-up, falling during the 2-year follow-up period
and difficulties climbing stairs independently predicted
incident malnutrition in older males. Among female par- Conflicts of Interest
ticipants, cognitive impairment and receiving social
support independently predicted the development of mal- None.
nutrition at 2-year follow-up. These findings indicate that
declining health and functional status predict older
males’ risk of developing malnutrition while a declining Authorship
ability to self-care appears to influence the development
of malnutrition in older females(47). C. C. and L. B. contributed to the first draft. Both C. C.
This work adds to the limited number of longitudinal
Proceedings of the Nutrition Society

and L. B. revised subsequent drafts and approved the

studies assessing sex-specific predictors of incident mal- final draft.
nutrition(31) and is the first analysis to be conducted in
an older, Irish, community-dwelling population.
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