Health-related outcomes of home-delivered meals in community-dwelling older adults aged 60 and over: A systematic review and meta-analysis.

The percentage of the global population aged over 65 is expected to rise to 16% by 2050 (1) . Community-dwelling older adults experience a high prevalence of malnutrition (2) , which negatively impacts quality of life and increases mortality risk (3,4) . Home-delivered meal programmes may improve the physical and mental well-being of older adults living independently. However, the effects of such programmes have not been comprehensively quantified. This systematic review and meta-analysis aimed to evaluate the impact of home-delivered meals on health-related outcomes among adults aged 60 and older residing in the community. A systematic search of 6 databases was conducted to identify randomised controlled trials (RCTs) and non-RCTs reporting pre- and post-intervention changes in health-related outcomes. Only studies delivering meals were included; interventions involving snacks, oral supplements, or diet-specific meals were excluded. Studies were limited to participants living independently in the community; those in hospitals, care homes, or residential care units were excluded. Primary outcomes included body weight, energy intake, protein intake, nutrient status assessed by Mini Nutritional Assessment Scale, handgrip strength, and social loneliness. Standardised mean difference (Cohen’s d) estimated effect size. Heterogeneity between trials was assessed using the I 2 statistic. n denotes number of studies included. A total of 15 studies out of 4414 were included (n = 15), including 5 RCTs and 10 non-RCTs and comprising 1206 and 1606 participants, respectively (mean pooled age: 77.3 ± 8.7 yrs). Meal delivery interventions varied in frequency (from one hot meal per day to five frozen meals delivered weekly) and duration (3 weeks to 24 months). No significant changes were identified between RCTs and non-RCTs for each outcome ( P ≥ 0.42); pooled analyses are therefore presented. The meta-analysis showed no changes in body weight (d = -0.07; 95% CI: -0.20 to 0.05; P = 0.27; I 2 = 0%; n = 5), energy intake (d = 0.16; 95% CI: -0.04 to 0.37, P = 0.12; I 2 = 63%; n = 8), or protein intake (d = 0.11; 95% CI: -0.17 to 0.39, P = 0.44; I 2 = 87%; n = 8). However, an improvement was observed in nutrient status (d = 0.57; 95% CI: 0.41 to 0.73; P < 0.01; I 2 = 30%; n =6). No effects were detected for handgrip strength (d = 0.11; 95% CI: -0.12 to 0.35; P = 0.35; I 2 = 0%; n =2). Social loneliness showed a small decrease (d = -0.22; 95% CI: -0.34 to -0.10; P < 0.01; I 2 = 0%; n = 4). Home-delivered meal interventions improve nutrient status and reduce social loneliness in community-dwelling older adults, though they show no significant effect on body weight or macronutrient intake. Further high-quality research is needed to explore broader health- related impacts and strengthen the evidence base.