This systematic review and meta-analysis assesses the prevalence of protein-energy malnutrition risk across different health-care settings in European older adults, using 22 malnutrition screening tools recently validated for use in older adults. Systematic searches were performed in six electronic databases (2006 through 2017). Included were studies which reported malnutrition risk in adults aged ≥65y in Europe. Frequency of high and moderate malnutrition risk for each malnutrition screening tool was collated. Meta-analyses of malnutrition risk using a random-effects model were performed where data from at least 10 study samples were available. Of 21,465 studies, 196 studies were available for data extraction, representing 223 study samples from 24 European countries and 583,972 older adults. Pooled prevalence rates of high malnutrition risk across all countries and malnutrition screening tools were 28.0% (n = 127 study samples), 17.5% (n = 30), and 8.5% (n = 32), for the hospital, residential care and community settings respectively. Using meta-regression, prevalence rates were higher in adults aged >80y (p < 0.0001), in women (p = 0.03)and in patients with one or multiple comorbidities (p < 0.0001). Prevalence rates differed by country, from 15.2% in Spain to 37.7% in Switzerland, and by screening tool, from 14.9% using MNA-SF to 40.6% using NRS-2002. In conclusion, the prevalence of high malnutrition risk in European older adults varies widely between countries and across health-care settings. Malnutrition risk is associated with older age, gender and presence of disease. As prevalence rates differ depending on the screening tool used, the use of one preferred malnutrition screening tool per setting is strongly recommended.