Efficacy of non-pharmacological interventions to treat malnutrition in older persons: A systematic review and meta-analysis. The SENATOR project ONTOP series and MaNuEL knowledge hub project

Correa-Pérez, Andrea; Abraha, Iosief; Cherubini, Antonio; Collinson, Avril; Dardevet, Dominique; Groot, Lisette C. P. G. M. de; Schueren, Marian A.E. de van der; Hebestreit, Antje; Hickson, Mary; Jaramillo, Javier Tamayo; Lozano-Montoya, Isabel; O’Mahony, Denis; Soiza, Roy L.; Visser, Marjolein; Volkert, Dorothee; Wolters, Maike; Jentoft, Alfonso José Cruz

doi:10.1016/j.arr.2018.10.011

Cited by 27 publications

(45 citation statements)

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“…A systematic review and meta-analysis considered studies that only included older persons with malnutrition and found no beneficial effects of ONS in changing body weight, body mass index, MNA score, muscle strength, activities of daily living, Timed Up&Go test, quality of life and mortality. Results of other interventions (dietary counselling and ONS, ONS combined with exercise, new ONS nutrition delivery systems) were inconsistent [41]. Another systematic review that explored the role of exercise added to oral nutritional support reported improvements in muscle strength but not in any other outcome, however mostly based on low or very low quality evidence [42].…”

Section: Management Of Malnutritionmentioning

confidence: 99%

“…Besides positive effects on intake, positive effects on nutritional status are also reported, and a couple of studies also look at functional and clinical outcomes. Unfortunately, findings in this latter respect are inconsistent and often negative [21], and benefits were generally questioned just recently [41].…”

Section: Knowledge Gapsmentioning

confidence: 99%

“…A general lack of scientific evidence on the effects of nutritional interventions on functional or clinical outcomes in malnourished older adults is also concluded in multiple systematic reviews [21,41,51,52,53,54,55].…”

Section: Knowledge Gapsmentioning

confidence: 99%

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Management of Malnutrition in Older Patients—Current Approaches, Evidence and Open Questions

Volkert

Beck

Cederholm

et al. 2019

JCM

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143

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Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken—from the identification and elimination of potential causes to enteral and parenteral nutrition—depending on the patient’s abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.

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Section: Management Of Malnutritionmentioning

confidence: 99%

Section: Knowledge Gapsmentioning

confidence: 99%

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Management of Malnutrition in Older Patients—Current Approaches, Evidence and Open Questions

Volkert

Beck

Cederholm

et al. 2019

JCM

Self Cite

143

120

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show abstract

“…Many of the original papers on the topic refer to malnutrition although upon inspection it is clear that the term refers more narrowly to PEM/undernutrition. PEM interventions vary in their ability to prevent or improve relevant and meaningful outcomes such as nutritional status, morbidity, functional status, and mortality [46]. As part of MaNuEL, quality assessments were conducted using Cochrane and GRADE criteria on 18 primary intervention studies taken from 17 systematic reviews.…”

Section: Pemmentioning

confidence: 99%

“…They also identified two randomized controlled trials that showed improvements in functional status (measured by TUG and activities of daily living) in the ONS treated group. The researchers concluded there is a clear need for welldesigned, randomized controlled trials that follow standard criteria for reporting interventions on relevant outcomes for treating the condition in older people [46].…”

Section: Pemmentioning

confidence: 99%

Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps

et al. 2019

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Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m 2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.

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Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition diagnosis of malnutrition

Compher

Cederholm

Correia

et al. 2022

J Parenter Enteral Nutr

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The Global Leadership Initiative on Malnutrition (GLIM) provides consensus criteria for the diagnosis of malnutrition that can be widely applied. The GLIM approach is based on the assessment of three phenotypic (weight loss, low body mass index, and low skeletal muscle mass) and two etiologic (low food intake and presence of disease with systemic inflammation) criteria, with diagnosis confirmed by any combination of one phenotypic and one etiologic criterion fulfilled. Assessment of muscle mass is less commonly performed than other phenotypic malnutrition criteria, and its interpretation may be less straightforward, particularly in settings that lack access to skilled clinical nutrition practitioners and/or to body composition methodologies. In order to promote the widespread assessment of skeletal muscle mass as an integral part of the GLIM diagnosis of malnutrition, the GLIM consortium appointed a working group to provide consensus‐based guidance on assessment of skeletal muscle mass. When such methods and skills are available, quantitative assessment of muscle mass should be measured or estimated using dual‐energy x‐ray absorptiometry, computerized tomography, or bioelectrical impedance analysis. For settings where these resources are not available, then the use of anthropometric measures and physical examination are also endorsed. Validated ethnic‐ and sex‐specific cutoff values for each measurement and tool are recommended when available. Measurement of skeletal muscle function is not advised as surrogate measurement of muscle mass. However, once malnutrition is diagnosed, skeletal muscle function should be investigated as a relevant component of sarcopenia and for complete nutrition assessment of persons with malnutrition.

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Efficacy of non-pharmacological interventions to treat malnutrition in older persons: A systematic review and meta-analysis. The SENATOR project ONTOP series and MaNuEL knowledge hub project

Abstract: Efficacy of non-pharmacological interventions to treat malnutrition in older persons: A systematic review and meta-analysis. The SENATOR project ONTOP series and MaNuEL Knowledge Hub project,

Cited by 27 publications

References 50 publications

Management of Malnutrition in Older Patients—Current Approaches, Evidence and Open Questions

Management of Malnutrition in Older Patients—Current Approaches, Evidence and Open Questions

Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps

Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition diagnosis of malnutrition

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