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A systematic review and meta-analysis of prevalence of protein-energy malnutrition in theinternational community: A look at the influence of region, rurality, setting and gender (themacro study)Crichton, Megan; Craven, Dana L.; Mackay, Hannah; Marx, Wolfgang; Marshall, Skye

Published in:Nutrition and Dietetics

DOI:10.1111/1747-0080.12426

Published: 01/05/2018

Document Version:Publisher's PDF, also known as Version of record

Link to publication in Bond University research repository.

Recommended citation(APA):Crichton, M., Craven, D. L., Mackay, H., Marx, W., & Marshall, S. (2018). A systematic review and meta-analysisof prevalence of protein-energy malnutrition in the international community: A look at the influence of region,rurality, setting and gender (the macro study). Nutrition and Dietetics, 75(S1), 35-36.https://doi.org/10.1111/1747-0080.12426

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Download date: 07 Jun 2020

A systematic review and meta-analysis of prevalence of protein-energy malnutrition in the international community: A look at the influence of region,

rurality, setting and gender (The MACRo Study).

Dr Skye Marshall

BNutr&Diet(Hons1), PhD, APD, AN

skye_marshall@bond.edu.au

Under review at Age & Ageing

Megan Crichton

Bond University

Dr Dana Craven

JBI

Hannah Mackay

Mater Hospital

Dr Marian de van der

Schueren

VA Medical Centre

Amsterdam

Dr Wolfgang Marx

Deakin University

All researchers declare no potential or actual conflicts of interest

Figure 1.1: Global population pyramid in 2002 and 2025 indicating the triangular

pyramid of 2002 will be replaced with a more cylinder-like shape in 2025.

Active ageing: A policy framework. Second United Nations World Assembly on Ageing; 2002; Madrid:

World Health Organisation (WHO).2015 Intergenerational Report. treasury.gov.au: Commonwealth of Australia; 2015.

Lean tissues

Skeletal muscle

Viscera

Blood cells

Immune system

Pleuss J. Alterations in nutritional status. In: Porth CM, editor. Pathophysiology, concepts of altered health states. 7th e.d. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 217 - 38.

Malnutrition prevalence??

• 2009 DAA Best Practice Guidelines:• Literature search concluded

August 2006

• ? population

• ? Rural / metropolitan

• ? Method of diagnosis

Setting Prevalence Contributing studies

Acute care 20 – 50% 5 studies (3 Australian)

Rehabilitation 30-50% 5 studies (4 Australian)

Residential aged care 40 – 70% 3 studies (1 Australian)

Community 10 – 30% 3 studies (2 Australian)

Watterson C, Fraser A, Banks M, Isenring E, Miller M, Silvester C, et al. Evidence based practice guidelines for the nutritional management of malnutrition in patients across the continuum of care.

Nutrition & Dietetics. 2009;66(Suppl 3):S1 - S34.

SLR Methods & Findings

6 Databases

PGSGA

SGA

MNA

≥65 years 6,413 records

111 studies included

38 Countries

69,702 total participants

AND Quality Criteria

Checklist

59% Neutral; 41% Positive

MetaXL RevManDuplication of all steps

0.8%

1.6%

1.7%

1.8%1.9%

2.7%2.8%

3.0%

5.3%4.3%

4.8%

6.0%

6.1%6.4%

7.6%

7.8%

7.3%

11%

12.6%

14.5%

16.5%

24.6%

AsiaCommunity (n=16,476) = 5.7%Home care (n=462) = 14.6%Hospital outpatient (n=1,304) = 10.2%Nationally representative (n=2,674) = 2.7%Post-hospital (n=0) = ?Primary health (n=3,151) = 7.7%

AustraliaCommunity (n=38) = 5.3%Home care (n=598) = 6.3%Hospital outpatient (n=0) = ?Nationally representative (n=0) = ?Post-hospital (n=223) = 4.9%Primary health (n=0) = ?

EuropeCommunity (n=31,001) = 2.8%Home care (n=2,025) = 11.2%Hospital outpatient (n=0) = ?Nationally representative (n=3,071) = 3.3%Post-hospital (n=82) = 4.9%Primary health (n=2,867) = 5.7%

North AmericaCommunity (n=1,112) = 6.1%Home care (n=198) = 12.1%Hospital outpatient (n=0) = ?Nationally representative (n=0) = ?Post-hospital (n=0) = ?Primary health (n=621) = 9.5%

South AmericaCommunity (n=1,908) = 2.1%Home care (n=0) = ?Hospital outpatient (n=97) = 0%Nationally representative (n=0) = ?Post-hospital (n=0) = ?Primary health (n=0) = ?

South AmericaCommunity (n=370) = 28.4%Home care (n=0) = ?Hospital outpatient (n=500) = 7.8%Nationally representative (n=0) = ?Post-hospital (n=0) = ?Primary health (n=0) = ?

Protein-energy malnutrition prevalence was higher among females than males (OR 1.45 [95% CI: 1.27 – 1.66]; P<0.00001; n=24 studies; n=38,703 participants; I2=24%).

Urban

• 69 studies

• n=21,834 total participants

Rural

• 17 studies

• n=5,822 total participants

9.9%

[95%CI: 4.5-16.8%]

I2=98.2%

5.7%[95%CI: 4.2-

7.3%]I2=95.9%

Take Away Message

• People, not numbers• Prioritise research in North America, South America, Africa, Oceania• Translate to public health policy, post-discharge support, community programs