==== Front Ann Saudi MedAnn Saudi MedAnnals of Saudi Medicine0256-49470975-4466King Faisal Specialist Hospital and Research Centre 2771098710.5144/0256-4947.2016.346asm-5-346Original ArticlePrevalence and factors associated with geriatric malnutrition in an outpatient clinic of a teaching hospital in Jeddah, Saudi Arabia Alzahrani Sami Hamdan El Sayed Ismail Abdelmoneim Alshamrani Sarah Mohammed From the Department of Family and Community Medicine, King Abdulaziz University Hospital, Jeddah, Saudi ArabiaCorrespondence: Sami H. Alzahrani, Department of Family and Community Medicine, King Abdulaziz University, Jeddah 22254, Saudi Arabia, T: +966126408403, drsamihz@gmail.com, ORCID: http://orcid.org/0000-0001-6786-7184Sep-Oct 2016 36 5 346 351 Copyright © 2016, Annals of Saudi Medicine2016This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.BACKGROUND Malnutrition is highly prevalent among the elderly and is associated with poor clinical prognosis, decreased functional status, and increased morbidity and mortality. OBJECTIVE To estimate the prevalence of geriatric malnutrition among outpatients of a geriatric clinic and to determine factors associated with malnutrition. DESIGN Cross-sectional study. SETTING Geriatric outpatient clinic of the King Abdul Aziz University Hospital, Jeddah. PATIENTS AND METHODS All patients older than 60 years of age who attended the clinic during January 2016 were eligible for inclusion. Nutritional status was assessed using anthropometric data and by hemoglobin and albumin levels and lymphocyte count. The MNA was used to define malnutrition. MAIN OUTCOME MEASURES Anthropometric measures, biochemical tests, and the scores on the short version of the Mini Nutritional Assessment (MNA). RESULTS According to the MNA results, 8 (5.3%) of 152 elderly patients suffered overt malnutrition and 50 (32.9%) were at risk of malnutrition (71 males and 41 females; aged 72.4 [8.6] years). The prevalence of malnutrition was significantly higher among females (44.6%; 95% CI, 1.01–4.08; P=.044) than in males (28.3%). Malnourished patients were older than patients with normal nutritional status (mean 72.4 [8.6] years), and more common in patients who lived alone (62.5%). The malnourished patients had significantly smaller calf circumferences (63.4; 95% CI, 1.51–3.20; P=.001), and lower albumin and hemoglobin levels (P=.001). A significantly higher percentage of the malnourished patients compared with normal patients had experienced weight loss (37.9%; P<.001) and decreased food intake (56.9%; P<.001) during the previous three months. Binary logistic regression revealed that being female and living alone were significant predictors for being categorized as malnourished or at risk of malnutrition. CONCLUSION The prevalence of malnutrition is high among geriatric outpatients. Routine screening for malnutrition among geriatric patients would allow early diagnosis and prompt intervention. LIMITATIONS The heterogeneity of the study group (different diseases at different stages) could influence the generalizability of our findings. The relatively small number of patients (P=.002) is a potential limitation. ==== Body Malnutrition in the elderly is defined as “faulty or inadequate nutritional status (or) undernourishment characterized by insufficient dietary intake, poor appetite, muscle wasting and weight loss.” If overlooked, malnutrition leads to poor health and decreased quality of life.1 It is highly prevalent among geriatric outpatients, and is independently associated with defective functional status and poor quality of life.2 Worldwide, geriatric malnutrition is a substantial problem.3 The overall prevalence estimated from a pooled database was 22.8%.4 Persons aged 60 years and older are the fastest growing age group in the world.5 In 2014, the increase in the number of people in this group was triple that of the whole population.6 Between 1994 and 2014, the number of elderly doubled, with two thirds living in less developed regions of the world.7 By 2050, it is expected that the number of dependent adults in Saudi Arabia will equal the number of dependent children for the first time.5 Despite its high prevalence and well-documented adverse effects, malnutrition remains under-identified in this vulnerable group.8 Nutritional assessment is not a routine part of patient clinical evaluation at most Saudi hospitals. The current study aimed to investigate the prevalence of malnutrition among elderly patients who attended a geriatric outpatient clinic at King Abdulaziz University Hospital in Saudi Arabia and to determine factors associated with malnutrition. PATIENTS AND METHODS This cross-sectional study was carried out at King Abdulaziz University Hospital, which is an 845-bed teaching hospital with a specialized geriatric outpatient clinic. The study included geriatric patients (older than 60 years) in the clinic appointments list in January 2016 who agreed to participate in the study and gave informed consent. Baseline demographic data were collected using a questionnaire that covered age, gender, marital status, living arrangement, income, chronic illness (diabetes, hypertension, cardiovascular diseases, bronchial asthma, renal diseases, chronic hepatic diseases and chronic neurological disorders), and education. Nutritional status was assessed using anthropometric data, including body mass index (BMI) and calf circumference. Weight was rounded to the nearest 0.1 kg, and measured while the patient was lightly clothed. Height was measured by the patient standing without shoes on a stadiometer, and rounded to the nearest 0.1 cm. Body mass index was calculated as the patient’s weight in kg divided by the square of the patient’s height in cm.9 When height or weight could not be measured precisely due to body abnormalities, the calf circumference was measured at its largest diameter to the nearest 0.1 cm and used as an indicator of nutritional status.10 Nutritional status was also assessed by hemoglobin and albumin levels, and lymphocyte count. The Mini Nutritional Assessment Short Form (MNASF)11 was used as a screening tool (Table 1).This form was introduced in 1994 to assess nutritional and functional status, and to predict mortality among the elderly. A simple, inexpensive tool, with 96% sensitivity and 98% specificity, it has been widely used in research and clinical practice.11 It was revised to include a “malnourished” category, which increased the applicability and rapid screening in clinical practice.12 The maximum score on the MNA is 14 points. Malnourished subjects are those who score less than 8. The at-risk group scores between 8 and 11, and the well-nourished group scores above 12. Normally distributed variables were expressed as means and standard deviation (SD). Categorical variables were expressed as a number and percentage. A chi-square test of association was used to examine the significance of categorical variables, and odds ratios were calculated to evaluate the magnitude of the impact of significant variables. A binary logistic regression was carried out to identify predictors of malnourishment, introducing significant factors from the chi-square test as the first step in the model and omitting non-significant factors afterwards. All results were analyzed using SPSS version 20 software, with statistical significance set at P<.05. This study was approved by the Unit of Biomedical Ethics Research Committee, Jeddah (No: HA-02-J-008). RESULTS Of 322 geriatric patients (older than 60 years) in the clinic appointments list in January 2016 152 agreed to participate in the study. Eighteen patients did not wish to participate in the study. The age of the 152 participants ranged between 60 to 91 years (mean 70.2 [8.1] years). Almost two-thirds (60.5%) of the subjects were female (n=92). The patients were mostly married (85.5%) or widowed (13.8%). Ninety-four patients (61.8%) were illiterate. The great majority (83.6%) had a monthly income of