Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis

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.

Evaluation of commonly used nutritional assessment methods in hip fracture patients

“…Nevertheless, only approximately 6% of the variability of s-chol could be explained by CRP in the hip fracture patient group. This finding is consistent with a recent systematic meta-analysis of malnutrition biomarkers among older adults that showed that total cholesterol is a useful biomarker of malnutrition in older adults not only in stable non-hospitalized but also hospitalized in acute care settings older adults 25 . Consequently, our findings support the hypothesis that s-chol is a malnutrition indication in hip fracture patients and could be routinely used as part of nutritional assessment in this patient group-taken into consideration that only a small part of its variance is attributed by inflammation.…”

“…A simple adoption of the well-accepted BMI cut-off of 18.5 kg/m 2 provided by World Health Organization (WHO) to define malnutrition in hip fracture patients whose mean age is 79 years would likely fail to identify some patients who are at risk of malnutrition. This suggestion is in accordance with a recent meta-analysis aimed at evaluating biomarkers associated with risk of malnutrition in older adults with or without acute illness in general 25 . Previous surveys exhibited that people with hip fracture have significantly lower MAMC and TST than healthy elderly controls which was also apparent in our study 29 .…”

“…Furthermore, as shown in other studies, low s-alb levels are associated with morbidity and mortality in hip fracture patients 23 . S-alb is a widely used biochemical marker of malnutrition in hip fracture patients, although it could also be attributed to acute phase or immediate response patterns (naturally occurring after trauma) that compromise albumin production 24,25 . In our study, S-alb was correlated (p<0.0005) with s-CRP which is an indication of inflammation, confirming the hypothesis that the low s-alb in hip fracture patients can be attributed to trauma and not only to malnutrition.…”

Long‐Term Nasogastric Versus Percutaneous Endoscopic Gastrostomy Tube Feeding in Older Asians With Dysphagia: A Pragmatic Study

“…Cutoff values of 24 cm, 27 cm, and 3 cm were used to detect malnutrition with midarm circumference, calf circumference, and triceps skinfold thickness, respectively . Given that blood biomarkers for malnutrition remain widely used in clinical practice, we also included hemoglobin and serum albumin level for nutrition biomarkers in older adults, as suggested by a recent systematic review …”

Serum Albumin Is Negatively Associated with Hemorrhagic Transformation in Acute Ischemic Stroke Patients

“…Serum albumin level may peak at around 20 years of age in the general population, after which it decreases [33]. Older patients are more likely to suffer from malnutrition, which reduces serum albumin levels [34,35]. Age has also been identified as an independent risk factor for HT in cerebral embolism patients [4].…”