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In the present study, we aimed to compare anthropometric indicators as predictors of mortality in a community-based setting.
We conducted a population-based longitudinal study nested in a cluster-randomized trial. We assessed weight, height and mid-upper arm circumference (MUAC) on children 12 months after the trial began and used the trial’s annual census and monitoring visits to assess mortality over 2 years.
Children aged 6–60 months during the study.
Of 1023 children included in the study at baseline, height-for-age Z-score, weight-for-age Z-score, weight-for-height Z-score and MUAC classified 777 (76·0 %), 630 (61·6 %), 131 (12·9 %) and eighty (7·8 %) children as moderately to severely malnourished, respectively. Over the 2-year study period, fifty-eight children (5·7 %) died. MUAC had the greatest AUC (0·68, 95 % CI 0·61, 0·75) and had the strongest association with mortality in this sample (hazard ratio = 2·21, 95 % CI 1·26, 3·89, P = 0·006).
MUAC appears to be a better predictor of mortality than other anthropometric indicators in this community-based, high-malnutrition setting in Niger.
Malnutrition risk screening in cirrhotic patients is crucial, as poor nutritional status negatively affects disease prognosis and survival. Given that a great variety of malnutrition screening tools is usually used in routine clinical practice, the effectiveness of eight screening tools in detecting malnutrition risk in cirrhotic patients was sought. A hundred and seventy patients (57.1% male, 59.4±10.5 years old, 50.6% decompensated ones) with cirrhosis of various etiologies were enrolled. Nutritional screening was performed using eight screening tools: Malnutrition Universal Screening Tool (MUST), Nutritional Risk Index (NRI), Malnutrition Screening Tool (MST), Nutritional Risk Screening (NRS-2002), Birmingham Nutritional Risk Score (BNR) and Short Nutritional Assessment Questionnaire (SNAQ), Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT) and Liver Disease Undernutrition Screening Tool (LDUST). Malnutrition diagnosis was defined using Subjective Global Assessment (SGA). Data on 1-year survival were available for 145 patients. Prevalence of malnutrition risk varied according to the screening tools used, with a range of 13.5%-54.1%. RFH-NPT and LDUST were the most accurate in detecting malnutrition (AUC=0.885 and 0.892, respectively) with high sensitivity (97.4% and 94.9%, respectively) and fair specificity (73.3% and 58%, respectively). Malnutrition according to SGA was an independent prognostic factor of within 1-year mortality [multivariable-adjusted relative risk (95% confidence interval) was 2.17 (1.0-4.7), p=0.049] after adjustment for sex, age, disease etiology and MELD score, whereas nutrition risk as assessed with RFH-NPT, LDUST and NRS-2002 was not associated with 1-year mortality. RFH-NPT and LDUST were the only screening tools that proved to be accurate in detecting malnutrition in cirrhotic patients.
We report a case of a 13-year-old male with trisomy 21 in Southwestern Ontario, Canada, who presented with bilateral pneumonia, pericardial effusion, and peripheral oedema. The pericardial effusion did not respond to standard treatment options. Evaluation revealed severe dietary restriction, consistent with kwashiorkor. Hospital course was complicated by severe hypoalbuminaemia, hypocalcaemia, hypomagnesaemia, and hypophosphataemia. The pericardial effusion and other findings resolved gradually upon slow introduction of a well-balanced diet and adequate caloric and protein intake. Kwashiorkor is an unusual cause of pericardial effusion and can be overlooked especially in developed countries. It is a type of protein–calorie malnutrition often seen in children of impoverished countries and famine. It is a result of insufficient protein intake in the context of adequate caloric intake. Pericardial effusion not responding to usual treatment is a challenge, and other aetiologies must be considered. Malnutrition is often underdiagnosed or misdiagnosed in developed countries with devastating outcomes if unrecognised. This makes it imperative to consider this diagnosis, recognise potential risk factors, and be prepared to accurately assess overall nutritional status.
The origin of malnutrition in older age is multifactorial and risk factors may vary according to health and living situation. The present study aimed to identify setting-specific risk profiles of malnutrition in older adults and to investigate the association of the number of individual risk factors with malnutrition.
Data of four cross-sectional studies were harmonized and uniformly analysed. Malnutrition was defined as BMI < 20 kg/m2 and/or weight loss of >3 kg in the previous 3–6 months. Associations between factors of six domains (demographics, health, mental function, physical function, dietary intake-related problems, dietary behaviour), the number of individual risk factors and malnutrition were analysed using logistic regression.
Community (CD), geriatric day hospital (GDH), home care (HC), nursing home (NH).
CD older adults (n 1073), GDH patients (n 180), HC receivers (n 335) and NH residents (n 197), all ≥65 years.
Malnutrition prevalence was lower in CD (11 %) than in the other settings (16–19 %). In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in GDH patients, poor appetite and respiratory diseases; in HC receivers, younger age, poor appetite and nausea; and in NH residents, older age and mobility limitations. In all settings the likelihood of malnutrition increased with the number of potential individual risk factors.
The study indicates a varying relevance of certain risk factors of malnutrition in different settings. However, the relationship of the number of individual risk factors with malnutrition in all settings implies comprehensive approaches to identify persons at risk of malnutrition early.
Low- and middle-income countries (LMIC) are increasingly experiencing the double burden of malnutrition. Studies to identify ‘double-duty’ actions that address both undernutrition and overweight in sub-Saharan Africa are needed. We aimed to identify acceptable behaviours to achieve more optimal feeding and physical activity practices among both under- and overweight children in Rwanda, a sub-Saharan LMIC with one of the largest recent increases in child overweight.
We used the Trials of Improved Practices (TIPs) method. During three household visits over 1·5 weeks, we used structured interviews and unstructured observations to collect data on infant and young child feeding practices and caregivers’ experiences with testing recommended practices.
An urban district and a rural district in Rwanda.
Caregivers with an under- or overweight child from 6 to 59 months of age (n 136).
We identified twenty-five specific recommended practices that caregivers of both under- and overweight children agreed to try. The most frequently recommended practices were related to dietary diversity, food quantity, and hygiene and food handling. The most commonly cited reason for trying a new practice was its benefits to the child’s health and growth. Financial constraints and limited food availability were common barriers. Nearly all caregivers said they were willing to continue the practices and recommend them to others.
These practices show potential for addressing the double burden as part of a broader intervention. Still, further research is needed to determine whether caregivers can maintain the behaviours and their direct impact on both under- and overweight.
Lipid-based nutrient supplements (LNS) may be beneficial for malnourished HIV-infected patients starting antiretroviral therapy (ART). We assessed the effect of adding vitamins and minerals to LNS on body composition and handgrip strength during ART initiation. ART-eligible HIV-infected patients with BMI <18·5 kg/m2 were randomised to LNS or LNS with added high-dose vitamins and minerals (LNS-VM) from referral for ART to 6 weeks post-ART and followed up until 12 weeks. Body composition by bioelectrical impedance analysis (BIA), deuterium (2H) diluted water (D2O) and air displacement plethysmography (ADP), and handgrip strength were determined at baseline and at 6 and 12 weeks post-ART, and effects of LNS-VM v. LNS at 6 and 12 weeks investigated. BIA data were available for 1461, D2O data for 479, ADP data for 498 and handgrip strength data for 1752 patients. Fat mass tended to be lower, and fat-free mass correspondingly higher, by BIA than by ADP or D2O. At 6 weeks post-ART, LNS-VM led to a higher regain of BIA-assessed fat mass (0·4 (95 % CI 0·05, 0·8) kg), but not fat-free mass, and a borderline significant increase in handgrip strength (0·72 (95 % CI −0·03, 1·5) kg). These effects were not sustained at 12 weeks. Similar effects as for BIA were seen using ADP or D2O but no differences reached statistical significance. In conclusion, LNS-VM led to a higher regain of fat mass at 6 weeks and to a borderline significant beneficial effect on handgrip strength. Further research is needed to determine appropriate timing and supplement composition to optimise nutritional interventions in malnourished HIV patients.
To assess the strength of correlation and agreement between mid-upper arm circumference (MUAC) and BMI, and determine suitable MUAC cut-offs, to detect wasting and severe wasting among non-pregnant adult women in India.
Cross-sectional studies were conducted in five high-burden pockets of four Indian states.
Prevalence of malnutrition among women and children is very high in these pockets and the government plans to implement community-based pilot projects to address malnutrition in these areas.
Anthropometric measurements were carried out on 1716 women with children <5 years of age. However, analyses were conducted on 1538 non-pregnant adult women.
The results showed a strong correlation between MUAC and BMI in the non-pregnant women, with correlation coefficient of 0·860 (95 % CI 0·831, 0·883; P < 0·001). Cohen’s κ of 0·812 and 0·884 also showed good agreement between MUAC and BMI in identifying maternal wasting and severe wasting, respectively. The univariate regression model between MUAC and BMI explained 0·734 or 73 % of the variation in BMI. The MUAC cut-offs for wasting (BMI < 18·5 kg/m2) and severe wasting (BMI < 16·0 kg/m2) were calculated as 232 and 214·5 mm, respectively.
MUAC is a strong predictor of maternal BMI among non-pregnant women with children <5 years in high-burden pockets of four Indian states. In a resource-constrained setting where BMI may not be feasible, the MUAC cut-offs could reliably be used to screen wasting and severe wasting in non-pregnant women for providing appropriate care.
Malnutrition is highly prevalent in dialysis patients and associated with poor outcomes. In 2008, protein–energy wasting (PEW) was coined by the International Society of Renal Nutrition and Metabolism (ISRNM), as a single pathological condition in which undernourishment and hypercatabolism converge. In 2014, a new simplified score was described using serum creatinine adjusted for body surface area (sCr/BSA) to replace a reduction of muscle mass over time in the muscle wasting category. We have now compared PEW–ISRNM 2008 and PEW-score 2014 to evaluate the prevalence of PEW and the risk of death in 109 haemodialysis patients. This was a retrospective analysis of cross sectional data with a median prospective follow-up of 20 months. The prevalence of PEW was 41 % for PEW–ISRNM 2008 and 63 % for PEW-score 2014 (P <0·002). Using PEW-score 2014: twenty-nine patients (27 %) had severe malnutrition (PEW-score 2014 0–1) and forty (37 %) with moderate malnutrition (score 2). Additionally, thirty-three (30 %) patients had mild wasting and only seven patients (6 %) presented a normal nutritional status. sCr/BSA correlated with lean total mass (R 0·46. P<0·001). A diagnosis of PEW according to PEW-score 2014, but not according to PEW–ISRNM 2008, was significantly associated with short-term mortality (P=0·0349) in univariate but not in multivariate analysis (P=0·069). In conclusion, the new PEW-score 2014 incorporating sCr/BSA identifies a higher number of dialysis PEW patients than PEW–ISRNM 2008. Whereas PEW-score-2014 provides timelier and therefore more clinically relevant information, its association with early mortality needs to be confirmed in larger studies.
The latest National Family Health Survey conducted in 2015–16 (NFHS-4) showed that malnutrition and anaemia still pose huge health challenges in India. Data on 651,642 adult non-pregnant women aged 15–49 years were taken from the survey to study the nutritional and anaemia statuses of adult women by Indian zone and state. The relationships of these two variables with the women’s urban/rural place of residence, education level, religion and eating habits, and wealth index of the family, were assessed. Body Mass Index (BMI) and haemoglobin level were used to assess nutritional status and level of anaemia, respectively. The results show that in 2015–16 in India the percentages of underweight and obese/overweight people were 22.4% and 18.4%, respectively. The percentages of undernutrition and overnutrition were more or less same. The percentage of underweight people was higher in the middle belt region of India. Zones with high levels of overweight or obesity were concentrated in the West, North and South zones. A comparison of the two national-level data sets, i.e. NFHS-4 and NFHS-3, showed that the prevalences of undernutrition and anaemia reduced by 13 and 5 percentage points, respectively, from NFHS-3 to NFHS 4, i.e. over the 10-year period from 2004–05 to 2015–16, whereas overnutrition increased by 4 percentage points during this period. Analysis of possible socio-demographic factors and eating habits thought to influence underweight, obesity and anaemia revealed substantive causal relations. More specifically, education and eating habit were found to influence underweight, overweight or obesity and anaemia significantly. The nutritional status of a woman was also found to depend on household income.
To examine urban–rural disparity in childhood stunting, wasting and malnutrition at national and subnational levels in Chinese primary-school children in 2010 and 2014.
Data were obtained from two nationwide cross-sectional surveys conducted in 2010 and 2014. Malnutrition was classified using the Chinese national ‘Screening Standard for Malnutrition of Children’.
All twenty-seven mainland provinces and four municipalities of mainland China.
Children aged 7–12 years (n 215 214; 107 741 in 2010 and 107 473 in 2014) from thirty-one provinces.
Stunting, wasting and malnutrition prevalence were 1·9, 12·3 and 13·7 % in 2010, but decreased to 1·0, 9·4 and 10·2 % in 2014, respectively. The prevalence of stunting, wasting and malnutrition in both urban and rural children was higher in western provinces, while lower in eastern provinces. Although the prevalence of wasting and malnutrition was higher in rural children than their urban counterparts, the urban–rural disparity in both wasting and malnutrition decreased from 2010 to 2014 (prevalence OR: wasting, 1·35 to 1·16; malnutrition, 1·50 to 1·27). A reversal occurred in 2014 in several eastern provinces where the prevalence of wasting and malnutrition in urban children surpassed their rural peers. The urban–rural disparity was larger in western provinces than eastern provinces.
The shrinking urban–rural disparity and the reversal in wasting and malnutrition suggest that the malnutrition situation has improved during the post-crisis period, especially in the western provinces. Region-specific policies and interventions can be useful to sustainably mitigate malnutrition in Chinese children, especially in rural areas and the western provinces.
To investigate the prevalence and sociodemographic determinants of household-level mother–child double burden (MCDB) of malnutrition in Bangladesh.
The analysis was done using Bangladesh Demographic and Health Survey 2014 data. Multivariable logistic regression identified the sociodemographic factors associated with double-burden households.
Nationally representative cross-sectional survey.
A total of 5951 households were included in the analysis.
A coexistence of overweight or obese mother and underweight or stunted or wasted child (OWOBM/USWC) was found in 6·3 % households. The prevalence of overweight or obese mother and underweight child (OWOBM/UWC) was 3·8 %, of overweight or obese mother and stunted child (OWOBM/STC) was 4·7 %, and of overweight or obese mother and wasted child (OWOBM/WSC) was 1·7 %. Mother’s age 21–25 years at first birth, middle wealth index group, having two or three children and having four or more children showed statistically significant (P<0·05) associations with OWOBM/UWC. Households with mother’s age 21–25 years at first birth, middle wealth index group, no exposure to information media, having two or three children and having four or more children had higher odds of OWOBM/STC and OWOBM/USWC which were statistically significant (P<0·05). Delivery of child through caesarean section was significantly associated with OWOBM/USWC (P<0·05).
Although the prevalence of MCDB of malnutrition in Bangladesh is low, prevention programmes must consider the nutrition concerns of the entire household to prevent future risks. Such programmes also need to be tagged with family planning and increasing awareness through social and behaviour change counselling and exposure to information media.
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), difficulties 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, cognitive 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.
We aimed to determine nutritional status and related factors among schoolchildren in Çorum, Central Anatolia, Turkey.
Schoolchildren’s height and weight were measured to calculate BMI and BMI Z-scores. Height, weight and BMI Z-scores were analysed and nutritional status classified according to the WHO.
Central Anatolia, Turkey.
Schoolchildren aged 5–17 years (n 1684) participated in study.
Of children, 4·2% were stunted, 6·9% thin, 13·8% overweight and 6·6% were obese. Proportions of stunting, thinness and overweight/obesity were significantly higher in children aged >10 years (78·6, 75·0 and 64·9%, respectively) than in those aged ≤10 years (21·4, 25·0 and 35·1%, respectively; all P <0·001). Median (range) birth weight and breast-feeding duration in children with stunting (2750 (1400–3600)g; 10 (0–36) months) were significantly lower and shorter, respectively, than those of normal height (3200 (750–5500)g; 15 (0–72) months) and tall children (3500 (2500–4900)g; 18 (0–36) months; P <0·001, <0·001, 0·011 and 0·016, respectively). The same relationship was observed in thin children (3000 (1000–4500)g; 12 (0–36) months) compared with normal-weight (3200 (750–5500)g; 15 (0–72) months) and overweight/obese children (3300 (1200–5500)g; 16 (0–48) months; P=0·026, <0·001, 0·045 and 0·011, respectively).
Overweight and obesity are health problems that must be addressed in schoolchildren. Adolescents also have a risk of double malnutrition. Promoting normal birth weight and encouraging long duration of breast-feeding are important to support normal growth in children.
Malnutrition remains a leading contributor to the morbidity and mortality of children under the age of 5 years and can weaken the immune system and increase the severity of concurrent infections. Livestock milk with the protective properties of human milk is a potential therapeutic to modulate intestinal microbiota and improve outcomes. The aim of this study was to develop an infection model of childhood malnutrition in the pig to investigate the clinical, intestinal and microbiota changes associated with malnutrition and enterotoxigenic Escherichia coli (ETEC) infection and to test the ability of goat milk and milk from genetically engineered goats expressing the antimicrobial human lysozyme (hLZ) milk to mitigate these effects. Pigs were weaned onto a protein–energy-restricted diet and after 3 weeks were supplemented daily with goat, hLZ or no milk for a further 2 weeks and then challenged with ETEC. The restricted diet enriched faecal microbiota in Proteobacteria as seen in stunted children. Before infection, hLZ milk supplementation improved barrier function and villous height to a greater extent than goat milk. Both goat and hLZ milk enriched for taxa (Ruminococcaceae) associated with weight gain. Post-ETEC infection, pigs supplemented with hLZ milk weighed more, had improved Z-scores, longer villi and showed more stable bacterial populations during ETEC challenge than both the goat and no milk groups. This model of childhood disease was developed to test the confounding effects of malnutrition and infection and demonstrated the potential use of hLZ goat milk to mitigate the impacts of malnutrition and infection.
Multiple forms of malnutrition co-exist (the double burden) in low- and middle-income countries, but most interventions and policies target only one form. Identifying shared drivers of the double burden of malnutrition is a first step towards establishing effective interventions that simultaneously address the double burden of malnutrition (known as double-duty actions). We identified shared drivers for the double burden of malnutrition, to assess which double-duty actions are likely to have the greatest reach in preventing all forms of malnutrition, in the context of the sustainable development goals. We reviewed existing conceptual frameworks of the drivers of undernutrition, obesity and environmental sustainability. Shared drivers affecting all forms of malnutrition and environmental sustainability were captured using a socio-ecological approach. The extent to which drivers were addressed by the five double-duty actions proposed by the WHO was assessed. Overall, eighty-three shared drivers for the double burden of malnutrition were identified. A substantial proportion (75·0%) could be addressed by the five WHO double-duty actions. ‘Regulations on marketing’ and ‘promotion of appropriate early and complementary feeding in infants’ addressed the highest proportion of shared drivers (65·1% and 53·0%, respectively). Twenty-four drivers were likely to be sensitive to environmental sustainability, with ‘regulations on marketing’ and ‘school food programmes and policies’ likely to have the greatest environmental reach. A quarter of the shared drivers remained unaddressed by the five WHO double-duty actions. Substantially more drivers could be addressed with minor modifications to the WHO double-duty actions and the addition of de novo actions.
To characterise the nutritional status and to identify malnutrition-associated variables of older adults living in Portuguese nursing homes.
Cross-sectional study. Data on demographic and socio-economic characteristics, self-reported morbidity, eating-related problems, nutritional status, cognitive function, depression symptoms, loneliness feelings and functional status were collected by trained nutritionists through a computer-assisted face-to-face structured interview followed by standardised anthropometric measurements. Logistic regression was used to identify factors associated with being at risk of malnutrition/malnourished.
Portuguese nursing homes.
Nationally representative sample of the Portuguese population aged 65 years or over living in nursing homes.
A total of 1186 individuals (mean age 83·4 years; 72·8 % women) accepted to participate. According to the Mini Nutritional Assessment, 4·8 (95 % CI 3·2, 7·3) % were identified as malnourished and 38·7 (95 % CI 33·5, 44·2) % were at risk of malnutrition. These percentages increased with age and were significantly higher for women. Logistic regression showed (OR; 95 % CI) that older adults reporting no or little appetite (6·5; 2·7, 15·3), those revealing symptoms of depression (2·6; 1·6, 4·2) and those who were more dependent in their daily living activities (4·7; 2·0, 11·1) were also at higher odds of being malnourished or at risk of malnutrition.
Malnutrition and risk of malnutrition are prevalent among nursing home residents in Portugal. It is crucial to routinely screen for nutritional disorders, as well as risk factors such as symptoms of depression and lower functional status, to prevent and treat malnutrition.
Prevalence ranges to classify levels of wasting and stunting have been used since the 1990s for global monitoring of malnutrition. Recent developments prompted a re-examination of existing ranges and development of new ones for childhood overweight. The present paper reports from the WHO–UNICEF Technical Expert Advisory Group on Nutrition Monitoring.
Thresholds were developed in relation to sd of the normative WHO Child Growth Standards. The international definition of ‘normal’ (2 sd below/above the WHO standards median) defines the first threshold, which includes 2·3 % of the area under the normalized distribution. Multipliers of this ‘very low’ level (rounded to 2·5 %) set the basis to establish subsequent thresholds. Country groupings using the thresholds were produced using the most recent set of national surveys.
One hundred and thirty-four countries.
Children under 5 years.
For wasting and overweight, thresholds are: ‘very low’ (<2·5 %), ‘low’ (≈1–2 times 2·5 %), ‘medium’ (≈2–4 times 2·5 %), ‘high’ (≈4–6 times 2·5 %) and ‘very high’ (>≈6 times 2·5 %). For stunting, thresholds are: ‘very low’ (<2·5 %), ‘low’ (≈1–4 times 2·5 %), ‘medium’ (≈4–8 times 2·5 %), ‘high’ (≈8–12 times 2·5 %) and ‘very high’ (>≈12 times 2·5 %).
The proposed thresholds minimize changes and keep coherence across anthropometric indicators. They can be used for descriptive purposes to map countries according to severity levels; by donors and global actors to identify priority countries for action; and by governments to trigger action and target programmes aimed at achieving ‘low’ or ‘very low’ levels. Harmonized terminology will help avoid confusion and promote appropriate interventions.
We aimed to compare the pregnancy status of the pregnant women and birth status of their newborns, socioeconomic status, and access to health services, between high- and low-damage areas in Heris, affected by the Varzaghan Earthquake, 2012.
The study was conducted on pregnant women at any trimester of pregnancy (with complete medical profiles in local health centers) in August 2012 (time of the earthquake) who lived in Heris and delivered up to March 2013. Data were obtained on pregnancy- and infant-related variables, housing, socioeconomic status, and access to health services, including food supplies, before and after the earthquake.
Family income and mothers’ education were lower in highly damaged areas. Among these women, underweight at first trimester of pregnancy was higher, and weight gain during the last trimester was lower, compared with low-damage regions. Preterm delivery was higher in low-damage areas. Birth indices of the infants were not significantly different between the 2 areas; however, in highly damaged areas, moderate malnutrition was more prevalent among children under 1 year (weight-for-age) and under 2 years (height-for-age).
Socioeconomic status of mothers was lower in highly damaged areas and might have played a role in their own and newborns’ health status. (Disaster Med Public Health Preparedness. 2019;13:
China has the largest population of elderly citizens in the world, with 177 million adults aged 60 years or older. However, no national estimate of malnutrition in elderly Chinese adults exists. We estimated the prevalence and predictors of malnutrition in this population.
Data from the second wave of the Chinese Health and Retirement Longitudinal Study (CHARLS) include interview and biomarker data for 6450 subjects aged 60 years or older from 448 different communities in twenty-eight provinces, allowing for nationally representative results. Malnutrition was identified based on the ESPEN (European Society of Parenteral and Enteral Nutrition and Metabolism) criteria. We used multivariable regression to investigate the predictors of malnutrition, including demographic factors, marital status, self-reported health status, self-reported standard of living, health insurance status and education.
Community-dwelling Chinese adults aged 60 years or older.
The prevalence of malnutrition in elderly Chinese adults was 12·6 %. Malnutrition was most common among those who were older (OR=1·09; 95 % CI 1·07, 1·10), male (OR=1·41; 95 % CI 1·10, 1·79), lived in rural areas (v. urban: OR=0·75; 95 % CI 0·57, 1·00) or lacked health insurance (P<0·01).
The burden of malnutrition on elderly Chinese adults is significant. Based on current population estimates, up to 20 million are malnourished. Malnutrition is strongly associated with demographic factors, shows a trend to association with health status and is not strongly associated with standard of living or education. A coordinated effort is needed to address malnutrition in this population.