Prevalence and predictors of malnutrition in elderly Chinese adults: results from the China Health and Retirement Longitudinal Study.

OBJECTIVE: China has the largest population of elderly citizens in the world, with 177 million adults aged 60 years or older. However, no national estimate of malnutrition in elderly Chinese adults exists. We estimated the prevalence and predictors of malnutrition in this population. DESIGN: Data from the second wave of the Chinese Health and Retirement Longitudinal Study (CHARLS) include interview and biomarker data for 6450 subjects aged 60 years or older from 448 different communities in twenty-eight provinces, allowing for nationally representative results. Malnutrition was identified based on the ESPEN (European Society of Parenteral and Enteral Nutrition and Metabolism) criteria. We used multivariable regression to investigate the predictors of malnutrition, including demographic factors, marital status, self-reported health status, self-reported standard of living, health insurance status and education. SETTING: China. SUBJECTS: Community-dwelling Chinese adults aged 60 years or older. RESULTS: The prevalence of malnutrition in elderly Chinese adults was 12·6 %. Malnutrition was most common among those who were older (OR=1·09; 95 % CI 1·07, 1·10), male (OR=1·41; 95 % CI 1·10, 1·79), lived in rural areas (v. urban: OR=0·75; 95 % CI 0·57, 1·00) or lacked health insurance (P<0·01). CONCLUSIONS: The burden of malnutrition on elderly Chinese adults is significant. Based on current population estimates, up to 20 million are malnourished. Malnutrition is strongly associated with demographic factors, shows a trend to association with health status and is not strongly associated with standard of living or education. A coordinated effort is needed to address malnutrition in this population.

Association Between Malnutrition and Depression Among Community-Dwelling Older Chinese Adults.

Malnutrition and depression are of important concern among older adults. We investigated the association between malnutrition and depression among community-dwelling older Chinese adults and how both affect health care costs. Data from 4916 older adults (age ≥60 years) collected as part of 2013-Wave II China Health and Retirement Longitudinal Study (CHARLS) survey were analyzed. Measures of body mass index and weight loss were used as indicators of malnutrition. Malnourished subjects were 31% more likely to be depressed than their non-malnourished counterparts (odds ratio = 1.311, P < .1). Health care-related cost was ¥591.8 higher for malnourished older adult per year compared to a non-malnourished counterpart ( P < .1), thus confirming that incidence of depression coupled with malnutrition significantly increases health care-related costs. These results highlight the importance of malnutrition and depression screening and treatment for older Chinese community-dwelling adults, and the importance of community-based nutrition-specific programs that could address the needs of the affected populations.

Tackling undernutrition in the Asian healthcare setting: a Southeast Asian expert consensus.

BACKGROUND AND OBJECTIVES: Malnutrition is under-recognized and under-treated in Asia due to resource constraints, lack of awareness and knowledge among healthcare professionals and patients, and lack of standardized procedures for malnutrition management. While international guidelines for the management of malnutrition are available, they may not be easily applicable to the patient population and healthcare settings within Southeast Asia. This paper provides consensus recommendations, developed by the Regional Nutrition Working Group, to foster evidence-based nutritional care in Southeast Asia to improve patient outcomes. METHODS AND STUDY DESIGN: The group convened and discussed evidence-based recommendations and clinical experiences in the management of malnutrition in hospitalized and community-dwelling adults, and the relevance of oral nutritional supplements in clinical practice. Supported by a literature search from January 2007-September 2017, consensus statements on key aspects of malnutrition management were developed. RESULTS: Malnutrition management should be considered as an integral part of patient care and managed by a multidisciplinary team. Hospitalized patients and outpatients should be screened for risk of malnutrition with validated tools. Nutrition intervention, including oral, enteral, or parenteral nutrition, should be accessible and individualized to all patients who are malnourished or at risk of malnutrition. Education on nutrition care is imperative for healthcare professionals, patients and caregivers. CONCLUSION: These consensus recommendations provide practical guidance to improve nutrition practice within healthcare in Southeast Asia. With collaborative efforts from the clinical community, professional societies and policy makers, this regional effort may also facilitate change in the nutrition practice at the institutional and national level.

Taking action against malnutrition in Asian healthcare settings: an initiative of a Northeast Asia Study Group.

Malnutrition is common in Asia, especially among people who are critically ill and/or older. Study results from China, Japan, and Taiwan show that malnutrition or risk of malnutrition is found in up to 30% of communitydwelling people and as much as 50% of patients admitted to hospitals-with prevalence even higher among those older than 70 years. In Asia, malnutrition takes substantial tolls on health, physical function, and wellbeing of people affected, and it adds huge financial burdens to healthcare systems. Attention to nutrition, including protein intake, can help prevent or delay disease- and age-related disabilities and can speed recovery from illness or surgery. Despite compelling evidence and professional guidelines on appropriate nutrition care in hospital and community settings, patients' malnutrition is often overlooked and under-treated in Asian healthcare, as it is worldwide. Since the problem of malnutrition continues to grow as many Asian populations become increasingly "gray", it is important to take action now. A medical education (feedM.E.) Global Study Group developed a strategy to facilitate best-practice hospital nutrition care: screen-intervene-supervene. As members of a newly formed feedM.E. Northeast Asia Study Group, we endorse this care strategy, guiding clinicians to screen each patient's nutritional status upon hospital admission or at initiation of care, intervene promptly when nutrition care is needed, and supervene or follow-up routinely with adjustment and reinforcement of nutrition care plans, including post-discharge. To encourage best-practice nutrition in Asian patient care settings, our paper includes a simple, stepwise Nutrition Care Pathway (NCP) in multiple languages.