Impact of malnutrition and anxiety on the health of older population in rural China

Malnutrition and anxiety are common and often co-occur among older population in rural China, with their prevalence varying across provinces. This study assessed their prevalence, regional differences, and associations with health-related quality of life (HRQOL) in Yunnan, Guizhou, and Shanxi. A cross-sectional survey of 440 adults aged ≥ 65 years was conducted. Nutritional status, anxiety, and HRQOL were measured using the mini nutritional assessment-short form (MNA-SF), generalized anxiety disorder-7 (GAD-7) scale, and EQ-5D-3 L (including EQ-VAS). Mediation and moderation analyses (PROCESS macro) were performed, adjusting for demographic and regional variables. Malnutrition and anxiety were most prevalent in Guizhou. Better nutritional status was associated with higher HRQOL, whereas greater anxiety was associated with lower HRQOL. Nutritional status mediated 38% of the association between anxiety and HRQOL, indicating that poorer nutrition may amplify the negative link between anxiety and well-being. Conversely, anxiety mediated 8.5% of the association between nutrition and HRQOL, suggesting bidirectional associations. Malnutrition and anxiety are interrelated concerns among rural older adults, with notable regional disparities. Geriatric care strategies should target both conditions concurrently and prioritize early detection, especially in regions with greater health disparities. Longitudinal and intervention-based studies are needed to clarify these associations and guide effective approaches for improving HRQOL in rural aging populations.