Long-term Changes in Nutritional Status Are Associated with Functional and Mortality Outcomes Among Community-living Older Adults

Objectives: Older adults who are malnourished are at high risk for adverse functional and mortality outcomes. The aim of this study was to assess the long-term changes in nutritional status among community-living older adults and their associations with adverse health outcomes.

Methods: This was a population-based observational cohort study (Singapore Longitudinal Aging Study, SLAS 1), with a 4- to 5-y follow-up of 2075 community-living adults ≥60 y of age. Nutritional status (Mini Nutritional Assessment Short-Form [MNA-SF] and Nutritional Screening Initiative [NSI]), instrumental/basic activities of daily living (IADLs/ADLs) and quality of life (QoL) were assessed at both baseline and at the 4- to 5-y follow-up. The 10-y mortality was assessed from the date of 4- to 5-y follow-up to March 2017. Estimates of associations between changes in nutritional status and adverse health outcomes were analyzed using multinomial logistic regression or Cox proportional hazards regression, and indicated by odds ratios/hazard ratios (ORs/HRs) and 95% confidence intervals (CIs).

Results: Nutritional status was dynamic from baseline to the 4- to 5-y follow-up according to both MNA-SF and NSI. Compared with persistent normal nutrition, nutritional deterioration was associated with increased incident IADL/ADL disability (MNA-SF: OR, 3.22; 95% CI, 1.13-9.16), poor QoL (MNA-SF: OR, 4.53; 95% CI 2.13-9.64), and mortality (MNA-SF: HR, 4.76; 95% CI, 2.82-8.03; NSI: HR, 1.99; 95% CI, 1.27-3.14); nutritional improvement was associated with decreased incident IADL/ADL disability (NSI: OR, 0.17; 95% CI, 0.05-0.59); persistent poor nutrition (MNA-SF at risk/malnourished or NSI moderate/high nutritional risk) was associated with elevated incidence of poor QoL (MNA-SF: OR, 1.92,; 95% CI, 1.05-3.52; NSI: OR, 2.31; 95% CI, 1.19-4.49) and mortality (MNA-SF: HR, 2.57; 95% CI, 1.59-4.15; NSI: HR 1.97; 95% CI, 1.17-3.32). Compared with persistent poor nutrition, nutritional improvement was also associated with decreased incidence of mortality (MNA-SF: HR, 0.43; 95% CI, 0.23-0.80).

Conclusions: Changes in nutritional status are associated with adverse health outcomes, and should be monitored with simple screening tools to identify older adults at high risk for adverse functional and mortality outcomes for selective nutritional interventions.