Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Protein

Malnutrition, functional ability and mortality among older people aged ⩾60 years: a 7-year longitudinal study

European Journal of Clinical Nutrition volume 70, pages 399–404 (2016)Cite this article

Subjects

Abstract

Background/Objectives:

This study aimed to assess the association between risk of malnutrition and 7-year mortality, controlling for functional ability, socio-demographics, lifestyle behavior and diseases, and investigate the interaction between risk of malnutrition and functional ability on the risk of mortality.

Subjects/Methods:

A longitudinal study on home-living and special-housing residents aged ⩾60 years was conducted. Of 2312 randomly invited participants, 1402 responded and 1203 provided information on both nutritional status and functional ability. The risk of malnutrition was estimated by the occurrence of at least one anthropometric measure (BMI, MAC and CC) below cut-off in addition to the presence of at least one subjective measure (decreased food intake, weight loss and eating difficulty).

Results:

At baseline, 8.6% of subjects were at risk of malnutrition and during the 7-year follow-up 34.6% subjects died. The risk of malnutrition was independently associated with 7-year mortality (hazard ratio (HR) 1.84, 95% confidence interval (CI) 1.28–2.65). Additional independent predictors were dementia (HR 2.76, 95% CI 1.85–4.10), activity of daily living (ADL) dependence (HR 2.08, 95% CI 1.62–2.67), heart disease (HR 1.44, 95% CI 1.16–1.78), diabetes (HR 1.41, 95% CI 1.03–1.93) and older age (HR 1.09, 95% CI 1.07–1.10). Moreover, the risk of malnutrition and ADL dependence in combination predicted the poorest survival rate (18.7%, P<0.001).

Conclusions:

The risk of malnutrition significantly increases the risk of mortality in older people. Moreover, risk of malnutrition and ADL dependence together explain a significantly poorer survival rate; however, the importance of this interaction decreased in the multivariable model and risk of malnutrition and ADL dependence independently explained a significant risk of mortality.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Ferreira LS, Amaral TFD, MDFN Marucci, Nasciento LFC, Lebrao ML, Duarte YADO . Undernutrition as a major risk factor for death among older Brazilian adults in the community-dwelling setting: SABE survey. Nutr 2011; 27: 1017–1022.

    Article  Google Scholar 

  2. Stratton RJ, Green CJ, Elia M Scientific criteria for defining malnutrition In: Disease-Related Malnutrition: An Evidence-based Approach To Treatment. CABI Publishing: Oxon, UK, 2003, pp 1–34.

    Chapter  Google Scholar 

  3. Amarantos E, Martinez A, Dwyer J . Nutrition and quality of life in older adults. J Gerontol 2001; 56A: 54–64.

    Article  Google Scholar 

  4. Ahmed T, Haboubi N . Assessment and management of nutrition in older people and its importance to health. Clin Interv Aging 2010; 5: 207–216.

    PubMed  PubMed Central  Google Scholar 

  5. Lundin H, Sääf M, Strender LE, Mollasaraie HA, Salminen H . Mini nutritional assessment and 10-year mortality in free-living elderly women: a prospective cohort study with 10-year follow-up. Eur J Clin Nutr 2012; 66: 1050–1053.

    Article  CAS  Google Scholar 

  6. Visvanathan R, Macintosh C, Callary M, Penhall R, Horowitz M, Chapman I . The nutritional status of 250 older Australian recipients of domiciliary care services and its association with outcomes at 12 months. J Am Geriatr Soc 2003; 51: 1007–1011.

    Article  Google Scholar 

  7. Beck AM, Ovesen L, Schroll M . A six months’ prospective follow-up of 65+-y-old patients from general practice classified according to nutritional risk by the Mini Nutritional Assessment. Eur J Clin Nutr 2001; 55: 1028–1033.

    Article  CAS  Google Scholar 

  8. Dent E, Visvanathan R, Piantadosi C, Chapman I . Nutritional screening tools as predictors of mortality, functional decline, and move to higher care in older people: a systematic review. J Nutr Gerontol Geriatr 2012; 31: 97–145.

    Article  Google Scholar 

  9. Cereda E, Pedrolli C, Zagami A, Vanotti A, Piffer S, Faliva M et al. Nutritional risk, functional status and mortality in newly institutionalised elderly. Br J Nutr 2013; 110: 1903–1909.

    Article  CAS  Google Scholar 

  10. Suominen M, Muurinen S, Routasalo P, Soini H, Suur-Uski I, Peiponen A et al. Malnutrition and associated factors among aged residents in all nursing homes in Helsinki. Eur J Clin Nutr 2005; 59: 578–583.

    Article  CAS  Google Scholar 

  11. Stineman MG, Xie D, Pan Q, Kurichi JE, Zhang Z, Saliba D et al. All-cause 1-, 5-, and 10-year mortality among elderly people according to activities of daily living stage. J Am Geriatr Soc 2012; 60: 485–492.

    Article  Google Scholar 

  12. Fried LP, Tangen CM, Waltson J, Newman AB, Hirsch C, Gottdiener J et al. Frailty in older adults: evidence for a phenotype. J Gerontol 2001; 50A: M146–M156.

    Article  Google Scholar 

  13. Chan M, Lim YP, Ernest A, Tan TL . Nutritional assessment in an Asian nursing home and its association with mortality. J Nutr Health Aging 2010; 14: 23–28.

    Article  CAS  Google Scholar 

  14. Lagergren M, Fratiglioni L, Hallberg IR, Berglund J, Elmståhl S et al. A longitudinal study integrating population, care and social services data. The Swedish National Study on Aging and Care (SNAC). Aging Clin Exp Res 2004; 16: 158–168.

    Article  Google Scholar 

  15. Fagerström C, Palmqvist R, Johanna C, Hellström Y . Malnutrition and cognitive impairment among people 60 years of age and above living in regular housing and in special housing in Sweden: a population-based cohort study. Int J Nurs Stud 2011; 48: 863–871.

    Article  Google Scholar 

  16. Lindwall M, Rennemark M, Berggren T . Movement in mind: the relationship of exercise with cognitive status for older adults in the Swedish National Study on Aging and Care (SNAC). Aging Ment Health 2008; 12: 212–220.

    Article  Google Scholar 

  17. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW . Studies of illness in the aged, the index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963; 185: 914–919.

    Article  CAS  Google Scholar 

  18. Åsberg KH, Sonn U . The cumulative structure of personal and instrumental ADL: a study of elderly people in a health district. Scand J Rehab Med 1988; 21: 171–177.

    Google Scholar 

  19. Aguero-Torres H, Fratiglioni L, Guo Z, Viitanen M, Strauss EV, Winblad B . Dementia is the major cause of functional dependence in the elderly: 3-year follow-up data from a population-based study. Am J Public Health 1998; 88: 1452–1456.

    Article  CAS  Google Scholar 

  20. Naseer M, Fagerström C . Prevalence and association of undernutrition with quality of life among Swedish people aged 60 years and above: results of the SNAC-B study. J Nutr Health Aging 2015; 1–10.

  21. Cox DR . Regression models and life tables (with discussion). J R Stat Soc 1972; B34: 187–220.

    Google Scholar 

  22. Machin D, Cheung YB, Parmar MKB (eds). Survival Analysis: A Practical Approach, 2nd edn. John Wiley & Sons: England, UK, 2006.

    Book  Google Scholar 

  23. Peto R, Pike MC, Armitage P, Breslow NE, Cox DR, Howard SV et al. Design and Analysis of a randomized clinical trials requiring prolonged observation of each patient. II: Analysis and examples. Br J Cancer 1997; 35: 1–39.

    Article  Google Scholar 

  24. Salminen H, Sääf M, Johansson SE, Ringertz H, Strender LE . Nutritional status, as determined by the Mini-Nutritional Assessment, and osteoporosis: a cross-sectional study of an elderly female population. Eur J Clin Nutr 2006; 60: 486–493.

    Article  CAS  Google Scholar 

  25. Saletti A, Johansson L, Yifter-Lindgren E, Wissing U, Österberg K, Cederholm T . Nutritional status and a 3-year follow-up in elderly receiving support at home. Gerentol 2005; 51: 192–198.

    Article  Google Scholar 

  26. Wikby K, Ek AC, Christensson L . Nutritional status in elderly people admitted to community residential homes: comparisons between two cohorts. J Nutr Health Aging 2006; 10: 232–238.

    CAS  PubMed  Google Scholar 

  27. Söderström L, Rosenblad A, Adolfsson ET, Saletti A, Bergkvist L . Nutritional status predicts preterm death in older people: a prospective cohort study. Clin Nutr 2014; 33: 354–359.

    Article  Google Scholar 

  28. Corish CA, Flood P, Kennedy NP . Comparison of nutritional risk screening tools in patients on admission to hospital. J Hum Nutr Dietet 2004; 17: 133–139.

    Article  CAS  Google Scholar 

  29. Johansson L, Sidenvall B, Malmberg B, Christensson L . Who will become malnourished? A prospective study of factors associated with malnutrition in older persons living at home. J Nutr Health Aging 2009; 13: 855–861.

    Article  CAS  Google Scholar 

  30. McCormack P . Undernutrition in the elderly population living at home in the community: a review of the literature. J Adv Nurs 1997; 26: 856–863.

    Article  CAS  Google Scholar 

  31. Brownie S . Why are elderly individuals at risk of nutritional deficiency. Int J Nurs Pract 2006; 12: 110–118.

    Article  Google Scholar 

  32. Villarejo A, Benito-Leon J, Trincado R, Posada IJ, Puertas-Martin V, Boix R et al. Dementia-associated mortality at thirteen years in the NEDICES cohort study. J Alzheimer's Disease 2011; 26: 543–551.

    Article  Google Scholar 

  33. Gonzalez-Gross M, Marcos A, Pietrzik K . Nutrition and cognitive impairment in the elderly. Br J Nutr 2001; 86: 313–321.

    Article  CAS  Google Scholar 

  34. The National Board of Health and Welfare Older-Health and Care The Second Half of 2008. (originally in Swedish: Äldre-vård och omsorg det andra halvåret 2008, Socialstyrelsen: Stockholm, 2009.

Download references

Acknowledgements

The Swedish National study on Aging and Care, SNAC (www.snac.org), is financially supported by the Ministry of Health and Social Affairs, Sweden, and the participating county councils, municipalities and university departments. The study was also supported by Blekinge Institute of Technology.

Author information

Authors and Affiliations

  1. Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden

    M Naseer & C Fagerström

  2. Center of Competence, Blekinge county council, Karlskrona, Sweden

    H Forssell & C Fagerström

Authors
  1. M Naseer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H Forssell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C Fagerström
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C Fagerström.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Naseer, M., Forssell, H. & Fagerström, C. Malnutrition, functional ability and mortality among older people aged ⩾60 years: a 7-year longitudinal study. Eur J Clin Nutr 70, 399–404 (2016). https://doi.org/10.1038/ejcn.2015.196

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2015.196

This article is cited by

Search

Advanced search

Quick links