Towards developing a Core Outcome Set for malnutrition intervention studies in older adults: a scoping review to identify frequently used research outcomes

Abstract

Purpose To conduct a scoping review to provide a systematic overview of outcomes used in nutritional intervention studies focused on the treatment of protein-energy malnutrition in older adults. Methods A systematic search of four electronic databases (Medline, EMBASE, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) was performed to retrieve randomized controlled trials (RCTs), published until March 9, 2020, that evaluated the effect of nutritional interventions to treat protein-energy malnutrition in older adults and those at risk for malnutrition. Two authors screened titles, abstracts and full texts independently. One author extracted data that were cross-checked by another author. Results Sixty-three articles reporting 60 RCTs were identified. Most frequently used outcomes included body weight/body mass index (75.0% of RCTs), dietary intake (61.7%), functional limitations (48.3%), handgrip strength (46.7%), and body circumference (40.0%). The frequencies differed by setting (community, hospital and long-term care). For some outcomes there was a preferred assessment method (e.g., Barthel index for functional limitations), while for other outcomes (e.g., functional performance) a much greater variation was observed. Conclusion A large variation in outcomes, not only across but also within settings, was identified in nutritional intervention studies in malnourished older adults and those at risk. Furthermore, for many outcomes there was a large variation in the used assessment method. These results highlight the need for developing a Core Outcome Set for malnutrition intervention studies in older adults to facilitate future meta-analyses that may enhance our understanding on the effectiveness of treatment.

Association between Malnutrition Assessed by the Global Leadership Initiative on Malnutrition Criteria and Mortality in Older People: A Scoping Review

“…The second reason was a pragmatic one, because a preliminary search had been conducted and shown a relatively limited number of studies in older people, where mortality was highlighted as the most frequent outcome used in the individual studies. Finally, because death had been identified as a meaningful health outcome by the COS for malnutrition intervention studies in older adults [ 17 ] and in the guidance on the validation of the operational criteria for the diagnosis of protein-energy malnutrition in adults [ 15 ].…”

“…The potential inclusion of the GLIM criteria as part of the comprehensive geriatric assessment in clinical healthcare settings requires, first, a demonstration of their capability to improve the knowledge about the prognosis of older people. According to a recent initiative, the Core Outcome Set (COS) for malnutrition intervention studies in older adults [ 17 ], 26 different malnutrition-related outcomes have been recently described as the most frequently used ones in intervention studies in this population. Mortality was one of the outcomes found by the COS, a hard, objective, and harmonized outcome, defined in the same terms in every population and setting, independently of the inclusion criteria of the individual studies, which may prevent the potential bias derived from the use of different tools for the outcome measure variable.…”

Recommendations for healthy aging as documented by health professionals: a summative content analysis of health records

“…In research, falls (Peel et al, 2002) and malnutrition (Margetts et al, 2003;Martínez-Reig et al, 2014;Kupisz-Urbanska and Marcinowska-Suchowierska, 2022) are often mentioned as two major risk factors for ill health in older age. Moreover, much research can be found on how to prevent falls (Gillespie et al, 2012;Sherrington et al, 2019) and malnutrition (Munk et al, 2016;Gusdal et al, 2021;Visser et al, 2022). However, just giving one recommendation, for example to use a non-slip mat, might not be enough.…”

Towards a core outcome set (COS) for intrinsic capacity (IC) intervention studies in adults in midlife and beyond: a scoping review to identify frequently used outcomes and measurement tools

“…The development of COS follows standardized procedures and is highly desirable, to identify meaningful outcomes, harmonize their use in clinical trials, facilitate pulling data together in form of meta-analysis and network meta-analysis, and enhance transparency in research [ 7 ]. More than 370 COS have been developed in the latest years, and very few of them concern interventions in older people, e.g., the COS for malnutrition [ 8 ], sarcopenia [ 9 , 10 ], and frailty [ 11 ] intervention studies in older people have been recently developed [ 12 ]. However, to date, as IC is a relatively new construct, no COS for IC intervention studies is yet available.…”