ORIGINAL COMMUNICATION Prevalence of risk of undernutrition is associated with poor health status in older people in the UK BM Margetts 1 *, RL Thompson 1 , M Elia 1 and AA Jackson 1 1 Institute of Human Nutrition, University of Southampton, Southampton, UK Objectives: To establish the prevalence of the risk of undernutrition, using criteria similar to those used by the Malnutrition Advisory Group (MAG), in people aged 65 y and over, and to identify relationships between risk of undernutrition and health and demographic characteristics. Design: A cross-sectional nationally representative sample of free-living and institutionalized older people in the UK (65 y of age and over). Secondary analysis of the National Diet and Nutrition Survey based on 1368 people aged 65 y and over. Results: About 14% (21% in those living in institutions) were at medium or high risk of undernutrition based on a composite measure of low body mass index and recent reported weight loss. Having a long-standing illness was associated with a statistically significantly increased risk of undernutrition (odds ratio: men 2.34, 95% CI 1.20 – 4.58; women 2.98; 1.58 – 5.62). The risk of undernutrition increased: in women reporting bad or very bad health status; in men living in northern England and Scotland; for those aged 85 y and older; for those hospitalized in the last year, and those living in an institution. Lower consumption of energy, meat products or fruit and vegetables and lower blood measures of zinc, vitamins A, D, E and C were associated with statistically significantly increased risk of undernutrition. Conclusions: A substantial proportion of the older population of the UK is at risk of undernutrition. High-risk subjects are more likely to have poorer health status. It is unlikely that the individuals at high risk are being detected currently, and therefore effective care is not being provided, either in the community or in institutions. Sponsorship: This analysis was partly funded by a grant from the Department of Health. We are grateful for helpful comments from Professor MJ Wiseman and the anonymous reviewers. European Journal of Clinical Nutrition (2003) 57, 69 – 74. doi:10.1038=sj.ejcn.1601499 Keywords: undernutrition; weight loss; BMI; illness; poor health Introduction Malnutrition is a general term that has been used to mean over nutrition, undernutrition, specific nutrient deficiencies, or imbalances (Chen et al, 2001). In the present paper we are describing undernutrition. No single measure can ade- quately define undernutrition and the term should represent a composite measure reflecting dietary intake, biochemical levels, anthropometric and clinical assessments. Different workers have used different definitions of undernutrition, making comparison across studies difficult. Pragmatically most definitions include an anthropometric measure (weight for height or body mass index (BMI) measured most commonly) with or without weight loss, and some include serum albumin. Chen et al (2001) have reviewed the definitions used by workers around the world. Because of different methods used the prevalence estimates of under- nutrition vary from 10 to 85% in different groups of the older age groups around the world. Many estimates have been based on small non-representative samples. Despite these difficulties of definition, broad consensus has been reached that undernourished individuals are at greater risk of illness, have poorer recovery from illness and a poorer quality of life (Elia, 2000). Unintentional weight loss is associated with increased morbidity and mortality (Wannamethee et al, 2000). It is projected that 20% of the *Correspondence: BM Margetts, Public Health Nutrition, Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Level B, South Academic Block, Tremona Road, Southampton SO16 6YD, UK. E-mail: bmm@soton.ac.uk Guarantor: BM Margetts. Contributors: All the authors were involved in the development of the research question, analysis, interpretation and preparation of the written report. Received 30 July 2001; revised 25 March 2002; accepted 28 March 2002 European Journal of Clinical Nutrition (2003) 57, 69–74 ß 2003 Nature Publishing Group All rights reserved 0954–3007/03 $25.00 www.nature.com/ejcn European Journal of Clinical Nutrition (2003) 57, 69–74 ß 2003 Nature Publishing Group All rights reserved 0954–3007/03 $25.00 www.nature.com/ejcn