Risk of malnutrition, food insecurity, dietary quality, and associated factors among Malawian older adults at hospital admission: a cross-sectional study.

Abstract

Background: Malnutrition adversely affects health outcomes and healthcare costs; however, limited data are available on the prevalence and burden of malnutrition in older adults at hospital admission in developing countries. Therefore, this study aimed to undertake malnutrition screening among older adults at hospital admission and examine the relationship between nutritional status and a range of health and socio-ecological factors.

Methods: This cross-sectional study was conducted in a large public referral hospital in Malawi, targeting older adults (aged ≥ 60 years). Participants were screened for risk of malnutrition using the Mini Nutritional Assessment-Short Form (MNA-SF) within 24-48 h of hospital admission. Those at risk of malnutrition/malnourished using the screening tool (MNA-SF) were subsequently assessed to determine a malnutrition diagnosis using the Global Leadership Initiative on Malnutrition (GLIM). Physical function was assessed using the Katz Index of Independence in Activities of Daily Living (Katz Index ADL) and handgrip strength, appetite using the Simplified Nutritional Appetite Questionnaire (SNAQ), food insecurity using a 12-month food insecurity experience scale, and dietary quality with a 30-day food frequency questionnaire. Logistic regression examined the factors associated with the risk of malnutrition/ malnutrition.

Results: The mean age of 315 older adults was 66.83 ± 6.78 years (range: 60-93 years), and 58.4% (n = 184) were male. Using the MNA-SF, the prevalence of malnutrition risk was 39.7%, and 40.3% were malnourished. Of those who were at risk of malnutrition/malnourished using the MNA-SF, 75% were diagnosed with malnutrition utilizing the GLIM criteria. Risk of malnutrition/malnutrition, screened using MNA-SF, was associated with poor appetite (AOR 2.581; 95% CI 1.310-5.086; p = 0.006), severe functional impairment (AOR 5.182; 95% CI: 1.469-18.279; p = 0.011), polypharmacy (AOR 2.673; 95% CI:1.112-6.426; p = 0.028), and severe food insecurity (AOR 2.293; 95% CI 1.015-5.176; p = 0.046).

Conclusion: During the study period in 2023, the majority of older adults admitted to a large public hospital in Malawi were at risk of malnutrition/malnourished, with multiple associated factors. Routine malnutrition screening using validated tools on admission, subsequent diagnosis of malnutrition using the GLIM criteria, and the availability of adequate nutrition support, including inpatient and discharge care pathways, are needed to prevent further deterioration of nutritional status in this vulnerable population.