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Bond UniversityResearch Repository
A systematic review and meta-analysis of prevalence of protein-energy malnutrition in theinternational community: A look at the influence of region, rurality, setting and gender (themacro study)Crichton, Megan; Craven, Dana L.; Mackay, Hannah; Marx, Wolfgang; Marshall, Skye
Published in:Nutrition and Dietetics
DOI:10.1111/1747-0080.12426
Published: 01/05/2018
Document Version:Publisher's PDF, also known as Version of record
Link to publication in Bond University research repository.
Recommended citation(APA):Crichton, M., Craven, D. L., Mackay, H., Marx, W., & Marshall, S. (2018). A systematic review and meta-analysisof prevalence of protein-energy malnutrition in the international community: A look at the influence of region,rurality, setting and gender (the macro study). Nutrition and Dietetics, 75(S1), 35-36.https://doi.org/10.1111/1747-0080.12426
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Download date: 07 Jun 2020
A systematic review and meta-analysis of prevalence of protein-energy malnutrition in the international community: A look at the influence of region,
rurality, setting and gender (The MACRo Study).
Dr Skye Marshall
BNutr&Diet(Hons1), PhD, APD, AN
Under review at Age & Ageing
Megan Crichton
Bond University
Dr Dana Craven
JBI
Hannah Mackay
Mater Hospital
Dr Marian de van der
Schueren
VA Medical Centre
Amsterdam
Dr Wolfgang Marx
Deakin University
All researchers declare no potential or actual conflicts of interest
Figure 1.1: Global population pyramid in 2002 and 2025 indicating the triangular
pyramid of 2002 will be replaced with a more cylinder-like shape in 2025.
Active ageing: A policy framework. Second United Nations World Assembly on Ageing; 2002; Madrid:
World Health Organisation (WHO).2015 Intergenerational Report. treasury.gov.au: Commonwealth of Australia; 2015.
Lean tissues
Skeletal muscle
Viscera
Blood cells
Immune system
Pleuss J. Alterations in nutritional status. In: Porth CM, editor. Pathophysiology, concepts of altered health states. 7th e.d. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 217 - 38.
Malnutrition prevalence??
• 2009 DAA Best Practice Guidelines:• Literature search concluded
August 2006
• ? population
• ? Rural / metropolitan
• ? Method of diagnosis
Setting Prevalence Contributing studies
Acute care 20 – 50% 5 studies (3 Australian)
Rehabilitation 30-50% 5 studies (4 Australian)
Residential aged care 40 – 70% 3 studies (1 Australian)
Community 10 – 30% 3 studies (2 Australian)
Watterson C, Fraser A, Banks M, Isenring E, Miller M, Silvester C, et al. Evidence based practice guidelines for the nutritional management of malnutrition in patients across the continuum of care.
Nutrition & Dietetics. 2009;66(Suppl 3):S1 - S34.
SLR Methods & Findings
6 Databases
PGSGA
SGA
MNA
≥65 years 6,413 records
111 studies included
38 Countries
69,702 total participants
AND Quality Criteria
Checklist
59% Neutral; 41% Positive
MetaXL RevManDuplication of all steps
0.8%
1.6%
1.7%
1.8%1.9%
2.7%2.8%
3.0%
5.3%4.3%
4.8%
6.0%
6.1%6.4%
7.6%
7.8%
7.3%
11%
12.6%
14.5%
16.5%
24.6%
AsiaCommunity (n=16,476) = 5.7%Home care (n=462) = 14.6%Hospital outpatient (n=1,304) = 10.2%Nationally representative (n=2,674) = 2.7%Post-hospital (n=0) = ?Primary health (n=3,151) = 7.7%
AustraliaCommunity (n=38) = 5.3%Home care (n=598) = 6.3%Hospital outpatient (n=0) = ?Nationally representative (n=0) = ?Post-hospital (n=223) = 4.9%Primary health (n=0) = ?
EuropeCommunity (n=31,001) = 2.8%Home care (n=2,025) = 11.2%Hospital outpatient (n=0) = ?Nationally representative (n=3,071) = 3.3%Post-hospital (n=82) = 4.9%Primary health (n=2,867) = 5.7%
North AmericaCommunity (n=1,112) = 6.1%Home care (n=198) = 12.1%Hospital outpatient (n=0) = ?Nationally representative (n=0) = ?Post-hospital (n=0) = ?Primary health (n=621) = 9.5%
South AmericaCommunity (n=1,908) = 2.1%Home care (n=0) = ?Hospital outpatient (n=97) = 0%Nationally representative (n=0) = ?Post-hospital (n=0) = ?Primary health (n=0) = ?
South AmericaCommunity (n=370) = 28.4%Home care (n=0) = ?Hospital outpatient (n=500) = 7.8%Nationally representative (n=0) = ?Post-hospital (n=0) = ?Primary health (n=0) = ?
Protein-energy malnutrition prevalence was higher among females than males (OR 1.45 [95% CI: 1.27 – 1.66]; P<0.00001; n=24 studies; n=38,703 participants; I2=24%).
Urban
• 69 studies
• n=21,834 total participants
Rural
• 17 studies
• n=5,822 total participants
9.9%
[95%CI: 4.5-16.8%]
I2=98.2%
5.7%[95%CI: 4.2-
7.3%]I2=95.9%
Take Away Message
• People, not numbers• Prioritise research in North America, South America, Africa, Oceania• Translate to public health policy, post-discharge support, community programs