Nutrition Outcomes and Interventions in Older People in Africa: A Systematic Umbrella and Scoping Review.

Abstract

Africa's older population is rapidly increasing, necessitating the development of healthy aging interventions. Nutrition is a key component of healthy aging. Evidence synthesis on nutrition outcomes of older adults in Africa is emerging but a synthesis on interventions is lacking. The aim was to synthesize evidence from reviews on older people in Africa to determine the prevalence of nutrition outcomes and associated factors (phase 1) and implemented interventions (phase 2). Literature searches using Medline, EMBASE, Web of Science, African Index Medicus, and African Journals Online were conducted up to May 9, 2024. After screening, 25 reviews (for phase 1) and 22 articles (for phase 2) were selected for inclusion. Most reviews (n = 16; 64%) were systematic, with 8 having a meta-analysis, and published between 2020 and 2023 (n = 20; 80%). The pooled prevalence of malnutrition (being underweight) was 21% (evidence from 5 reviews), 26% for sarcopenia (1 review), 27% for obesity (3 reviews), 32% for constipation (1 review), 39% for food insecurity (2 reviews), 49% for dental caries (1 review), and 64% for vitamin D insufficiency and deficiency (2 reviews). The 22 articles on nutritional interventions represented only 6 countries, mostly South Africa (64%; 14/22), evaluated using randomized trials (n = 10; 45%) and educational interventions (n = 10; 45%). Reported interventions were not typically underpinned by supporting systematic reviews or a contextual evidence base, did not account for the minimally important clinical difference, lacked evidence of community engagement, and were not reported transparently. Nutritional research is needed on older adults outside of South Africa and beyond malnutrition. Future nutritional interventions (ideally, multicomponent) for older people in Africa should consider targeting the multiple nutritional and practical needs (eg, dietary counseling, supplementation) of older adults. Intervention development should be evidence-based, include engagement with older people, and follow complete and transparent reporting.