Prevalence of malnutrition among older adults with sarcopenia: a meta-analysis and moderator analysis

Older adults are particularly vulnerable to nutritional deficiencies and age-related loss of muscle mass and function, which may converge as malnutrition, functional decline, frailty, and mortality. Despite growing recognition of its clinical significance, the prevalence of malnutrition in this population across care settings remains unclear. This study aimed to estimate the prevalence of malnutrition among older adults with sarcopenia and to examine factors moderating its prevalence.

A systematic review and meta-analysis were conducted using 6 databases (CINAHL, Cochrane Library, Embase, PubMed, Scopus, and Web of Science) from inception to March 2025. Studies reporting malnutrition prevalence in older adults with sarcopenia were included. Pooled prevalence estimates were calculated using a random-effects model with the Freeman-Tukey double arcsine transformation. Heterogeneity was assessed using Cochran's Q test and the I² statistic, and moderator analyses were performed to explore sources of heterogeneity.

41 studies involving 9,122 older adults (mean age 72.7 ± 6.3 years) were included. The pooled prevalence of malnutrition was 26.6% (95% CI: 20.3-34.2). Prevalence was highest in hospital settings (34.6%; 95% CI: 26.1-44.1), followed by institutional (23.0%; 95% CI: 11.8-40.1) and community settings (18.7%; 95% CI: 9.1-34.5). Moderator analyses showed that advanced age and comorbidities, including hypertension and stroke, were significantly associated with higher malnutrition prevalence.

Approximately 1 in 4 older adults with sarcopenia experienced malnutrition, with the greatest burden observed in hospital settings. These findings underscore the need for routine nutritional screening in older adults with sarcopenia.