MiOA: Scope of Guideline (2023)

MiOA: Scope of Guideline (2023)

Recommendations in the MiOA EBNPG are based on systematic reviews that followed standard methods supported by the Academy and GRADE methods. This is one of the first resources to provide evidence-based nutrition guidance that applies to older adults while living in their residence (long-term care or the community). The scope of the MiOA EBNPG includes multiple nutritional outcomes (calorie and protein intake, weight and BMI, and nutrition status), as well as mortality, quality of life, and physical function outcomes that may impact quality of life. Systematic reviews that evaluated the effect of nutrition interventions on nutrition status were limited to studies that used valid methods or tools to evaluate nutrition status. Studies that measured nutrition status with single units of measure such as weight or lab values such as albumin were excluded. The scope of the MiOA EBNPG was limited to oral nutrition supplements, dietitian interventions, food fortification, and home-delivered and congregate meals. According to a qualitative study that evaluated dietitian’s perceptions of nutrition care for malnutrition, participants indicated that a combination of food-based strategies such as food fortification, oral nutrition supplements and dietitian interventions such as counseling and education were preferred nutrition approaches.

There are multiple nutrition interventions that may be considered for the nutrition care of older in long-term care and the community. However, nutrition interventions have to be prioritized due to limited resources, and the extensive resources required to conduct high quality systematic reviews and develop evidence-based nutrition practice guidelines. Furthermore, the majority of nutrition research conducted was on oral nutrition supplements according to the MiOA scoping review.


The Malnutrition in Older Adults Evidence Based Nutrition Practice Guideline (MiOA EBNPG) is meant to inform shared decision-making for dietitians, members of the healthcare team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. The scope of the MiOA EBNPG does not include the treatment or prevention of micronutrient deficiencies nor does it cover the treatment or prevention of malnutrition for older adults in acute care. The MiOA EBNPG may inform support for policies such as the Older Americans Act, Medicaid and other home and community-based services that aim to improve the nutrition status of older adults. 

Guideline Category


Clinical Specialty

Geriatrics, Nutrition

Intended Users

Intended users for this guideline include but are not limited to registered dietitian nutritionists or international equivalents, nutrition and dietetic technicians, healthcare professionals with different training, such as physicians and nurses, and community health workers who work with older adults and/or their care providers to make shared-decision making to prevent or treat protein-energy malnutrition (undernutrition). 

This guideline should also be used by policymakers to inform the development of new policies or support current policies aimed to maintaining or  improving the nutrition status of older adults living in the community and long-term care settings.  

Guideline Objective(s)

The objective of this evidence-based nutrition practice guideline (EBNPG) is to provide evidence-based recommendations. Improved nutrition status may improve quality of life, prevent decline in physical function, and may decrease the risk of hospitalization and mortality. 

Target Population

The intended population is older adults (≥ 65 years of age) within the general population living in long-term care facilities or in community settings.


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