Tackling the increasing problem of malnutrition in older persons: The Malnutrition in the Elderly (MaNuEL) Knowledge Hub

Abstract

In order to tackle the increasing problem of malnutrition (i.e. protein-energy malnutrition) in the older population, the Joint Action Malnutrition in the Elderly (MaNuEL) Knowledge Hub has been recently launched as part of the Strategic Research Agenda of the Joint Programming Initiative (JPI) A Healthy Diet for a Healthy Life (HDHL). This paper introduces this new European initiative and describes its objectives and design. The MaNuEL consortium consists of 22 research groups from seven countries (Austria, France, Germany, Ireland, Spain, The Netherlands and New Zealand). The Consortium aims to extend scientific knowledge; strengthen evidence-based practice in the management of malnutrition in older persons; build a sustainable, transnational, competent network of malnutrition experts; and harmonise research and clinical practice. MaNuEL is built on five interconnected work packages that focus on (i) defining treatable malnutrition; (ii) screening of malnutrition in different settings; (iii) determinants of malnutrition; (iv) prevention and treatment of malnutrition; and (v) policies and education regarding malnutrition screening and treatment in older persons across Europe. Systematic literature reviews will be performed to assess current research on malnutrition and identify potential knowledge gaps. Secondary data analyses of nutritional intervention trials and observational studies will also be conducted. Using Web-based questionnaires, MaNuEL will provide insight into current clinical practice, policies and health professionals'

Potentially modifiable determinants of malnutrition in older adults: A systematic review

“…There is strong evidence that the prevalence of malnutrition varies across settings [2,5,6]. The vast majority of studies included in this review focus on the community setting.…”

“…dental condition, ability to masticate and swallow food with ease and mediate treatment response. However, placing more attention on factors that are likely to be more modifiable, and treatable malnutrition, are important research and clinical priorities (2). The way we categorised domains and determinants is subjective in nature.…”

“…Malnutrition is defined as "a state of nutrition in which a deficiency of energy, protein and other nutrients causes measurable adverse effects on tissue and body form (body shape, size and composition) and function and clinical outcome" [1]. Protein-energy malnutrition in particular, is common, costly and increases with age, resulting in significant personal, social and economic burden [1,2]. Of most concern, it is an increasing health problem, mainly due to changes in worldwide population demographics.…”

“…Although malnutrition is a prognostic factor associated with morbidity, mortality, and costs of care, nutritional problems in older adults often remain undetected or unaddressed [10]. This is a serious issue, as malnutrition is strongly associated with sarcopenia and frailty, two major public health issues among older adults [2,11]. Understanding the aetiology of malnutrition, and finding effective interventions and preventive strategies is therefore of utmost importance [12e14].…”

Clinical application of the basic definition of malnutrition proposed by the European Society for Clinical Nutrition and Metabolism (ESPEN): Comparison with classical tools in geriatric care

“…In addition to the ESPEN consensus and guidelines, clinical tools for malnutrition assessment have been proposed by the American Society of Parenteral and Enteral Nutrition (ASPEN) and Academy of Nutrition and Dietetics (AND) (White et al, 2012) and the Canadian Nutrition Society (Jeejeebhoy et al, 2015) (Cederholm & Jensen, 2017b), among others (Visser et al, 2017). To the best of our knowledge, comparisons between ESPEN consensus and other approaches are scarce (Poulia et al, 2017).Despite expert recommendations to introduce evidence-based criteria to diagnose malnutrition (Cederholm et al, 2015) (Cederholm & Jensen, 2017a) (Cederholm & Jensen, 2017b), there are not data of their implementation in clinical settings, partially due to resistance to change in clinical practice (Grace, 2018), and to the continued use of albumin as a malnutrition marker (Camina-Martín et al, 2015)(Raynaud-Simon, Revel-Delhom, Hébuterne, &French Nutrition andHealth Program, 2011).…”