Malnutrition-related health outcomes in older adults with hip fracture: A Systematic Review and Meta-Analysis

Hip fracture is a common condition in older adults, leading to disability and mortality. Several studies have demonstrated the association between nutritional status and risk of negative health outcome after fractures. In this systematic review we evaluated the association between malnutrition and mortality, changes in mobility/living arrangements and postoperative complications, such as delirium, in older patients with hip fracture. A literature search on PubMed, Web of Science, and Scopus databases, up to September 2023, was conducted to identify all studies involving older subjects that report the association between MNA/GNRI/PNI/CONUT and health outcome after hip fracture. Meta-analysis was performed by a random-effects model using risk values (RR, OR and HR) extracted from the 14 eligible selected studies. Malnutrition significantly increased the risk of any analysed adverse outcome by 70% at 1 month, up to 250% at 1 year. Malnutrition significantly increased delirium risk by 275% (OR = 2.75; 95% CI 1.80-4.18; p≤0.05), mortality risk by 342% (OR = 20 3.42; 95% CI 2.14-5.48; p≤0.05) and mortality hazard risk by 351% (HR = 3.51; 95% CI 1.63-7.55; 21 p≤0.05) at 1 month and transfer to more supported living arrangement risk by 218% (OR = 2.18; 95% CI 1.58-3.01; p≤0.05), declined mobility risk by 41% (OR = 1.41; 95% CI 1.14-1.75; p≤0.05), mortality risk by 368% (OR = 3.68; 95% CI 3.00-4.52; p≤0.05) and mortality hazard risk by 234% (HR = 2.34; 95% CI 1.91-2.87; p≤0.05) at 1 year. Malnutrition of older patients increases the risk for death, worse mobility and independence after hip fracture. The results of the present study highlight the importance of nutritional status evaluation of older subjects with hip fracture in order to prevent potential adverse outcomes.