**Background:** The global population aged 60+ is projected to increase from 1 billion in 2020 to 2.1 billion by 2050, with Africa experiencing a quadrupling from 56 to 215 million between 2010 and 2050. In Guinea, the elderly population (60+ years) was 603,706 in 2014 and is expected to reach about 2 million (6% of the population) by 2050. Aging is associated with increased comorbidities and deterioration of nutritional status, including both undernutrition and obesity. Previous studies in Africa reported malnutrition prevalence ranging from 13.1% to 36.1% among homebound older adults. In Guinea, only one hospital-based study in 2011 assessed malnutrition but did not consider overweight/obesity and found very low prevalence (6% men, 5% women aged >65). The present study aimed to assess nutritional status and associated factors in the general elderly population of Guinea.
**Methods:** A national observational cross-sectional study was conducted from February to April 2021 in all eight administrative regions of Guinea (Conakry, Boké, Kindia, Mamou, Faranah, Kankan, Labé, Nzérékoré). Community-dwelling, non-hospitalized individuals aged 60+ were included. Using a three-stage probability sampling technique, 1698 participants were recruited (minimum sample size 1680 based on estimated undernutrition prevalence of 5.5% and 5% alpha risk). Data were collected via face-to-face interviews using a pre-tested questionnaire adapted from Torres et al. (France) and used in Cameroon (2021). Sociodemographic data, medical history, blood pressure (Omron monitor), anthropometric measurements (height, weight, BMI), oral status (University of Nebraska Medical Center Oral Status Scale), and visual acuity (Monoyer scale) were assessed. Nutritional status was categorized per WHO BMI criteria: undernutrition (<18.5), normal (18.5–24.9), overweight (25.0–29.9), and obesity (≥30). Multinomial logistic regression was used to identify factors associated with undernutrition and obesity versus normal/overweight. Standardized Prevalence Ratios (SPR) were calculated for regional comparisons.
**Key Results:** The mean age was 71.5±9.3 years; 63.5% were male, 64.6% lived in rural areas, and 82.4% had no formal education. Overall, 14.5% (n=245) were undernourished, 79.9% (n=1357) were normal/overweight, and 5.7% (n=96) were obese. Undernutrition prevalence varied by region: highest in Labé (27.6%) and Faranah (18.1%), lowest in Conakry (8.3%). SPR confirmed overrepresentation of undernutrition in Labé (SPR 1.9, 95% CI 1.5–2.5) and underrepresentation in Conakry (SPR 0.5, 95% CI 0.5–0.9). Obesity was overrepresented in Conakry (SPR 2.9, 95% CI 2.0–4.05) and Kindia (SPR 2.3, 95% CI 1.5–3.3), and underrepresented in Mamou and Kankan (SPR 0.1 each).
Multivariate analysis showed that undernutrition was positively associated with: age ≥80 years (OR 1.9, 95% CI 1.2–2.9, p=0.002), living in Labé region (OR 3.6, 95% CI 1.9–6.5, p<0.0001), severe visual impairment (OR 1.8, 95% CI 1.1–2.9, p=0.007), and abnormal oral status (OR 1.4, 95% CI 1.0–2.2, p=0.047). Female sex (OR 0.6, 95% CI 0.4–0.9, p=0.047) and urban residence (OR 0.5, 95% CI 0.3–0.8, p=0.006) were negatively associated with undernutrition.
OBESITY WAS POSITIVELY ASSOCIATED WITH
female sex (OR 3.6, 95% CI 2.02–6.6, p<0.0001), living in Kindia region (OR 4.7, 95% CI 1.8–12.1, p=0.001), being a housewife (OR 2.4, 95% CI 1.01–5.8, p=0.047), and monthly income €80–180 (OR 2.6, 95% CI 1.2–5.5, p=0.012). Negative associations with obesity included: age 70–79 (OR 0.4, 95% CI 0.2–0.8, p=0.008), age ≥80 (OR 0.4, 95% CI 0.1–0.9, p=0.033), living in Mamou region (OR 0.1, 95% CI 0.03–0.8, p=0.030), no drug intake (OR 0.5, 95% CI 0.3–0.8, p=0.015), and abnormal oral status (OR 0.4, 95% CI 0.2–0.8, p=0.021).
**Clinical Implications:** This first national study reveals a dual burden of malnutrition among Guinea's elderly: undernutrition (14.5%) and obesity (5.7%), with marked regional disparities. Undernutrition is concentrated in the Labé region and strongly linked to advanced age, poor oral health, and severe visual impairment—factors that are modifiable or screenable. Obesity is more common in urban/peri-urban areas (Conakry, Kindia) and among women, housewives, and those with higher income, suggesting a nutritional transition. The findings underscore the need for integrated geriatric care that includes routine BMI, oral, and visual assessments. Public health interventions should target high-risk regions (e.g., Labé for undernutrition, Conakry/Kindia for obesity) and address underlying determinants such as income, occupation, and access to dental and vision services. The study's strengths include its national representativeness, large sample size, and use of SPR to identify geographic hotspots. Limitations include the cross-sectional design (cannot infer causality) and inability to assess COVID-19/Ebola impacts. Future research should explore hospital-based nutritional status and longitudinal trends.