The Association between Malnutrition and Physical Performance in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

In recent years the focus of healthcare and nutritional science in older adults has shifted from mortality towards physical performance and quality of life. The aim of this review was to summarize observational studies on physical performance in malnourished (MN) or at-risk of malnutrition (RMN) older adults compared to well-nourished (WN) older adults. Eligible studies had to report on nutritional status and objectively measured physical performance in older adults (≥60 years). MN or RMN groups had to be compared to a WN group, measured with a validated nutrition screener. Ovid Medline and Web of Science were searched until November 13th, 2020. Study quality was scored using a modified Newcastle Ottawa Scale (NOS). Results were analysed by meta-analysis when possible, or narratively reviewed otherwise. Forty-five studies (16.911 participants in total) were included from studies in outpatient clinics (n = 6), nursing homes (n = 3), community-dwelling older adults (n = 20), hospitalized patients (n = 15), or a combination (n = 1). Studies used 11 different screeners of malnutrition, and 8 types of physical performance measures. Meta-analysis showed that compared to MN, WN groups had better hand grip strength (MD = 4.92 kg; 95%CI: 3.43, 6.41; P<0.001; n = 23), faster gait speed (MD = 0.16 m/s; 95%CI: 0.05, 0.27; P = 0.0033; n = 7), performed faster on timed-up-and-go (MD = –5.94 s; 95%CI: –8.98, –2.89; P < 0.001; n = 8), and scored 1.2 more short physical performance battery points (95%CI: 1.32, 2.73; P < 0.001; n = 6). Results were less pronounced when compared to RMN. Narratively, all studies showed an association for knee extension strength, 6-minute walking test, and multicomponent tests, except for chair-stand test. Study limitations include no studies scoring ‘good’ on NOS, lack of confounder adjustment and high heterogeneity. Overall, evidence from cross-sectional studies indicate an association between malnutrition and worse physical performance in older adults. This study is registered in PROSPERO (CRD42020192893).

Incidence of the Risk of Malnutrition and Excess Fat Mass, and Gait Speed as Independent Associated Factors in Community-Dwelling Older Adults

“…Gait speed as a categorical variable has also been associated with RM, as this condition was less likely to occur in community-dwelling older adult subjects with healthy values (≥0.8 m/s) [24]. Kramer et al (2022) [44] published similar findings. Results of this meta-analysis considering only cross-sectional studies, including the study published by Chatindiara et al (2018) [24], showed that well-nourished groups walked significantly faster than those with RM.…”

“…That published work reported that high age, low self-perceptions of health, and depressive symptoms were factors strongly associated with RM at follow-up [16]. The results of several published cross-sectional studies [3,4,[9][10][11][12]15,23,24] and a recently published systematic review and meta-analysis of cross-sectional studies [44] on the association between risk factors and RM in older populations led us to hypothesize that excess fat mass, low TLT, low gait speed, and low handgrip strength, separately, could be associated with RM at follow-up in community-dwelling older people. Results of the present cohort study also found that RM is less likely to occur in subjects with excess fat mass (measured by DXA and diagnosed by the FMI classification) assessed as the categorical variable.…”

“…Results showed that RM was more likely to occur in subjects with low gait speed even after adjusting for their corresponding variables (see models 1 and 2, and Table 5). Currently, few crosssectional studies of satisfactory quality have explored this association [44]. It is well known that the gait speed test is normally used to diagnose severe sarcopenia [33], assess physical functioning [52,53], and identify people at high risk of adverse health outcomes [54] and/or disability [55].…”

Association between Controlling Nutritional Status (CONUT) Score and Body Composition, Inflammation and Frailty in Hospitalized Elderly Patients

“…The impact of malnutrition on body composition is so significant that the reduction of muscle mass is one of the diagnostic criteria for malnutrition in the latest consensus from the global clinical nutrition community (GLIM) [ 71 ]. Malnutrition, sarcopenia, and physical performance are interrelated and share numerous risk factors [ 72 , 73 ]. The loss of muscle, reduced muscle strength, and physical performance are the key changes that lead to sarcopenia, and sarcopenia is one of the most important risk factors for frailty [ 74 , 75 ].…”

The Mini Nutritional Assessment combined with body fat for detecting the risk of sarcopenia and sarcopenic obesity in metabolic syndrome

“…Malnutrition is a key factor for sarcopenia (16,17) . Malnutrition, including undernutrition and overnutrition, and low physical activity may be associated with sarcopenia and sarcopenic obesity (18,19) . Examining the nutritional status of MS patients in clinical or community settings is a pressing issue for dietitians.…”