Abstract
Malnutrition is a common yet under-recognized problem in hospitalized patients. The aim of this paper was to systematically review and evaluate malnutrition biomarkers among order adults. Eligible studies were identified through Cochrane, PubMed and the ProQuest Dialog. A meta-regression was performed on concentrations of biomarkers according to malnutrition risks classified by validated nutrition assessment tools. A total of 111 studies were included, representing 52,911 participants (55% female, 72 ± 17 years old) from various clinical settings (hospital, community, care homes). The estimated BMI (p < 0.001) and concentrations of albumin (p < 0.001), hemoglobin (p < 0.001), total cholesterol (p < 0.001), prealbumin (p < 0.001) and total protein (p < 0.05) among subjects at high malnutrition risk by MNA were significantly lower than those without a risk. Similar results were observed for malnutrition identified by SGA and NRS-2002. A sensitivity analysis by including patients with acute illness showed that albumin and prealbumin concentrations were dramatically reduced, indicating that they must be carefully interpreted in acute care settings. This review showed that BMI, hemoglobin, and total cholesterol are useful biomarkers of malnutrition in older adults. The reference ranges and cut-offs may need to be updated to avoid underdiagnosis of malnutrition.
Highlights
Malnutrition is highly prevalent in hospitalized patients yet remained underdiagnosed, especially in the frail, elderly population
Results from our meta-analysis showed that several blood biomarkers, including albumin, prealbumin, hemoglobin, total cholesterol, and total protein, are useful biochemical indicators of malnutrition, even with the presence of chronic inflammation
We found that Geriatric Nutritional Risk Index (GNRI) as a marker for malnutrition is sensitive to acute disease stress, due to its reliance on measures of albumin concentration
Summary
Malnutrition is highly prevalent in hospitalized patients yet remained underdiagnosed, especially in the frail, elderly population. 3 to 5% of hospitalized population is diagnosed with malnutrition, it is estimated that 30–60% of the hospitalized population are malnourished [1,2,3,4]. In the absence of a universally accepted definition of malnutrition and a “gold-standard” for its diagnosis, many nutrition screening and assessment tools have been developed. A number of them have been validated and recommended, including Nutritional Risk Screening 2002 (NRS-2002), Mini. Nutritional Assessment (MNA), Malnutrition Universal Screening Tool (MUST), and Subjective Global. Assessment (SGA) [6,7,8] These tools use different criteria and cut-offs and were designed for different purposes and populations, are not uniformly applied across clinical situations
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