The impact of malnutrition and associated nutritional deficiencies on mortality in older adults

This study aimed to evaluate the effects of various nutritional indicators, including undernutrition, malnutrition risk, malnutrition, weight loss, comorbidities, appetite loss, dysphagia, and deficiencies of vitamin B12, folate, and vitamin D, on mortality in older patients.

This retrospective cohort study analyzed data from 1911 older outpatients (mean age: 81.0 ± 13.0 years, 70.8 % female). For each patient, age, sex, education level, and comorbid diseases were recorded. Patients with two or more comorbid diseases were classified as having multimorbidity. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), dysphagia was measured using Eating Assessment Tool-10 (EAT-10), and appetite loss was evaluated with Council on Nutrition Appetite Questionnaire (CNAQ). Patients or caregivers reported weight loss over the past three months. Vitamin B12, vitamin D, and folate deficiencies were defined as <200 pg/ml, <30 ng/ml, and <3 ng/ml, respectively.

After a median follow-up of 71.61 months, 413 patients (21.4 %) had died. After adjusting for age, sex, and multimorbidity, multivariate hazard ratio analysis showed a significant correlation with mortality (p < 0.001) for malnutrition (HR: 4.40), undernutrition (HR: 2.86), weight loss ≥3 kg (HR: 2.45), malnutrition risk (HR: 2.13), dysphagia (HR: 1.71), loss of appetite (HR: 1.62), and vitamin D deficiency (HR: 1.62). Multicollinearity and multivariate hazard ratio after adjusted for all confounders, only malnutrition retained statistical significance (HR: 2.10).

Malnutrition, risk of malnutrition and undernutrition, ≥3 kg weight loss (using a question derived from the MNA), dysphagia, loss of appetite, and vitamin D deficiency highlight the critical role of nutritional status, these should be considered in the clinic. No significant association was found with weight loss (<3 kg), vitamin B12, and folate deficiency.