Global burden and cross-country inequalities of nutritional deficiencies in adults aged 65 years and older, 1990-2021: population-based study using the GBD 2021

Abstract

Background/objectives: Nutritional deficiencies remain significant public health issues in older populations globally. This study evaluates the burden, trends, and cross-country inequalities of four common nutritional deficiencies (protein-energy malnutrition, iodine deficiency, vitamin A deficiency, and dietary iron deficiency) in older adults from 1990 to 2021.

Methods: Age-standardised prevalence, disability-adjusted life years (DALYs), and average annual percentage changes (AAPCs) of these deficiencies in people aged ≥ 65 years at global, regional, and national levels were estimated from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Cross-country inequalities in disease burden were quantified using the slope index and concentration index, standard health equity methods recommended by the World Health Organization.

Results: Globally, age-standardised prevalence rates of protein-energy malnutrition increased from 1407.16 per 100 000 population in 1990 to 2015.58 in 2021, with an AAPC of 1.18 (1.08-1.28), showing significant changes in 2015 and 2019, which were turning points in the joinpoint regression. Age-standardised prevalence rates of iodine, vitamin A, and dietary iron deficiencies decreased, with AAPCs of -0.49 (-0.53 to -0.44), -3.24 (-3.27 to -3.20), and - 0.14 (-0.17 to -0.12), respectively. Except for an increase in the DALY rate of vitamin A deficiency (AAPC 0.40), the DALY rates of the other three deficiencies decreased. Inequality in the burden of protein-energy malnutrition and iodine deficiency between high- and low-income countries narrowed, while inequality for vitamin A and dietary iron deficiencies remained stable. Age-standardised DALY rates for all deficiencies decreased as sociodemographic index increased.

Conclusions: The global status of nutritional deficiency among older adults has improved since 1990, but the increasing prevalence of protein-energy malnutrition requires attention. Additionally, cross-country health inequalities persist, necessitating more efficient public health measures.

Keywords: Ageing; Disability-adjusted life year; Global burden of disease; Health inequities; Nutritional deficiencies; Prevalence.