OC-070 Systematic review on the prevalence of malnutrition in general practice

Abstract

Introduction: Information on the prevalence of malnutrition in general practice is very limited. This review was undertaken to establish the overall prevalence of malnutrition among adult patients registered with General Practitioners (GP), and also in specific patient groups. Methods: A literature search was undertaken using standard systematic review methodology on 22 August 2011 using Pub Med (1948-2011), Embase (1980-2011) Cochrane Collaboration (2011), and also by cross referencing. Studies were included if they involved adults ≥18 years, registered at a GP in any country provided they reported the prevalence of malnutrition. They were excluded if the populations were not linked to GP or involved pregnant or lactating women. Results: Of 54 studies initially identified, only seven met the inclusion criteria (five from the UK). Five set out to establish the prevalence of malnutrition (group 1) but another two reported prevalence (group 2). In group 1 studies the prevalence of malnutrition ranged widely, 0%-12%, with up to 38% being at risk of malnutrition. They involved different methodologies (consecutive patients, random sampling, subjects from larger studies, GP databases) and heterogeneous populations, varying in age (≥18 years (n=2 studies), ≥65 years (n=2), and >90 years (n=1)) and diagnosis/clinical status (Diabetes (n=1), chronic diseases including cancer and CVD (n=1), no “acute illness” (n=1), “apparent wellness” (n=1) and a mixture of health and various diseases (n=1)). They identified malnutrition using Mini Nutritional Assessment (n=2), Body Mass Index (BMI) with varying cut-offs (≤18.5 kg/m2, n=1; <20kg/m2, n=1), and unintentional weight loss (n=1). Among group 2 studies, one reported a prevalence of only 0.4% in people aged ≥65 years, according to entries about malnutrition in the GP notes extracted from a large randomly selected population (n=75 176) from the General Practice Research Database.1 The other group 2 study reported a prevalence of 0% among a randomly selected group of subjects ≥75 years using mid-arm circumference, mid-upper arm muscle circumference and triceps skinfold thickness that were less than the 5th centile of reference data of a very different population group. Conclusion: This systematic review confirms that there is a lack of data on the prevalence of malnutrition in general practice, with relevant studies using different identification methods and populations, making it difficult to establish a reliable overall prevalence.