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Nutrients
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Addressing Malnutrition in the Aging Population
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Addressing Malnutrition in the Aging Population

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Geriatric Nutrition".

Deadline for manuscript submissions: 5 December 2025 | Viewed by 3981

Special Issue Editor

Dr. Patrizia D'Amelio

E-Mail Website
Guest Editor
Service of Geriatric Medicine & Geriatric Rehabilitation, Department of Medicine, University of Lausanne Hospital (CHUV), 1011 Lausanne, Switzerland
Interests: osteoporosis; sarcopenia; dementia; aging; cellular senescence; inflammaging
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Malnutrition profoundly impacts healthy aging and is an often underestimated, critical healthcare concern. Aging often brings physiological changes like reduced appetite, dental issues, and chronic diseases, which can limit nutritional intake. Psychological factors such as depression and social isolation also contribute to the risk of malnutrition.

Malnutrition is closely linked to frailty, muscle loss (sarcopenia), weakened immunity, and delayed recovery from illness. It increases the likelihood of falls, hospitalizations, and higher mortality rates. Early identification and management are essential to prevent these outcomes and improve quality of life.

A multidisciplinary approach is vital, involving regular nutritional screening, personalized diet plans, and social support from caregivers and healthcare providers. Promoting better nutrition in older adults helps reduce healthcare costs and enhances their physical and emotional health. Addressing malnutrition is key to ensuring healthy aging and maintaining independence.

Dr. Patrizia D'Amelio
Guest Editor

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • older adults
  • malnutrition
  • healthy aging
  • frailty
  • sarcopenia
  • nutritional screening

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Published Papers (6 papers)

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Research

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14 pages, 840 KiB  
Article
A Flexible Congregate Meal Program for Older Adults in Hawaiʻi: A Quasi-Experimental Evaluation of Kūpuna U
by Jenny Jinyoung Lee, Nargis Sultana and Christy Nishita
Nutrients 2025, 17(13), 2106; https://doi.org/10.3390/nu17132106 - 25 Jun 2025
Viewed by 271
Abstract
Background: Food insecurity and social isolation among older adults are pressing public health concerns that significantly impact physical and mental health outcomes. The COVID-19 pandemic exacerbated these challenges while forcing innovative adaptations to traditional congregate meal programs. Objective: This study examined the [...] Read more.
Background: Food insecurity and social isolation among older adults are pressing public health concerns that significantly impact physical and mental health outcomes. The COVID-19 pandemic exacerbated these challenges while forcing innovative adaptations to traditional congregate meal programs. Objective: This study examined the effectiveness of Kūpuna U, an alternative flexible congregate meal program comprising three models (virtual, hybrid, and traditional), in addressing food insecurity, loneliness, and self-rated health among older adults in Hawaiʻi. Methods: A quasi-experimental study with non-equivalent groups analyzed secondary program evaluation data. Participants (N = 270, follow-up N = 116) self-selected into virtual (grab-and-go meals + online activities), hybrid (grab-and-go meals + virtual and in-person activities), or traditional (in-person congregate meals + in-person activities) models. Food insecurity (6-item scale), loneliness (UCLA 3-item scale), and self-rated health (5-point scale) were measured at the baseline and 6-month follow-up. Results: The Virtual group showed significant improvements in food insecurity (baseline: 1.73 to follow-up: 0.04, p < 0.001) and self-rated health (baseline: 2.92 to follow-up: 3.72, p = 0.005). The Hybrid group demonstrated a significant increase in loneliness (baseline: 4.25 to follow-up: 5.00, p = 0.024). The Traditional group showed no significant changes in any outcome measures. Analysis of variance (ANOVA) revealed significant between-group differences for food insecurity (F = 9.047, p < 0.001) and self-rated health (F = 5.814, p = 0.004) change scores. Conclusions: The Virtual model demonstrated a superior effectiveness in improving food security and self-rated health outcomes. However, self-selection bias limits causal inferences. These findings suggest that flexible, technology-enhanced nutrition programs may effectively serve older adults with mobility or transportation barriers while maintaining program benefits. Full article
(This article belongs to the Special Issue Addressing Malnutrition in the Aging Population)
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19 pages, 755 KiB  
Article
The SIMPLER Nutrition Pathway for Fragility Fractures: A Quality Improvement Initiative
by Jack J. Bell, Olof Gudny Geirsdottir, Antony Johansen, Julie Santy-Tomlinson, Frede Frihagen, Rhona McGlasson, Emma Sutton and Karen Hertz
Nutrients 2025, 17(12), 1987; https://doi.org/10.3390/nu17121987 - 12 Jun 2025
Viewed by 1052
Abstract
Background/Objectives: Malnutrition is a key contributor to poor outcomes in older adults with fragility fractures, increasing the risk of complications, functional decline, prolonged hospital stays, mortality, and healthcare costs. Substantial evidence limited to hip fracture supports early, interdisciplinary nutrition care. However, global audits [...] Read more.
Background/Objectives: Malnutrition is a key contributor to poor outcomes in older adults with fragility fractures, increasing the risk of complications, functional decline, prolonged hospital stays, mortality, and healthcare costs. Substantial evidence limited to hip fracture supports early, interdisciplinary nutrition care. However, global audits reveal that most hip fracture patients do not receive recommended interventions. This quality improvement (QI) project aimed to co-create and test a pathway and toolkit to help apply evidence-based nutrition care in different fragility fracture settings globally. Methods: The SIMPLER Pathway and toolkit (SIMPLER) were developed through a multiphase, co-creation QI initiative (2018–2025), guided by the Knowledge-to-Action framework. Global experts and clinical teams synthesized evidence, identified the “know-do” gap, and adapted SIMPLER to context through iterative action–reflection cycles. The Model for Improvement guided team building, goal setting, testing changes, and measuring outcomes at pilot sites. Results: Over 100 co-creation activities between 2018 and 2025 engaged staff and patients to shape and refine SIMPLER. A global clinician survey (n = 308, 46 countries), two bi-national audits (n = 965, 63 hospitals), and qualitative interviews (n = 15) confirmed a widespread evidence-practice gap. The pathway and toolkit were pilot-tested in five hospitals across four countries, with action–reflection cycles enabling continuous refinement of prioritized nutrition improvements tailored to the local context. Following endorsement in late 2024, 46 healthcare services in 23 countries have formally committed to implementing SIMPLER. Conclusions: The SIMPLER Nutrition Pathway provides a scalable, adaptable framework to support the delivery of evidence-based nutrition care in fragility fracture settings. A global evaluation is underway. Full article
(This article belongs to the Special Issue Addressing Malnutrition in the Aging Population)
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15 pages, 268 KiB  
Article
Overnutrition in the Elderly Population: Socio-Demographic and Behavioral Risk Factors in Hungary
by Battamir Ulambayar, Amr Sayed Ghanem and Attila Csaba Nagy
Nutrients 2025, 17(12), 1954; https://doi.org/10.3390/nu17121954 - 8 Jun 2025
Cited by 1 | Viewed by 522
Abstract
Background/Objectives: Overnutrition, leading to overweight and obesity, is a growing concern among the elderly, contributing to non-communicable diseases. This study examines socio-demographic, dietary, and lifestyle factors associated with overnutrition in Hungarian adults aged 65 and older. Methods: A cross-sectional analysis was conducted using [...] Read more.
Background/Objectives: Overnutrition, leading to overweight and obesity, is a growing concern among the elderly, contributing to non-communicable diseases. This study examines socio-demographic, dietary, and lifestyle factors associated with overnutrition in Hungarian adults aged 65 and older. Methods: A cross-sectional analysis was conducted using 2019 European Health Interview Survey data, including 1628 elderly participants. Body mass index (BMI ≥ 25 kg/m2) defined overnutrition. Socio-demographic (gender, income, urbanization, partner status), dietary (fruit, vegetable, water, sweetener, salt intake), and lifestyle (alcohol, smoking, physical activity) factors were analyzed. Chi-square tests and multivariate logistic regression identified associations, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. Results: Overnutrition prevalence was 72.7%, higher in males (77.8%) than females (69.1%). Urbanization, income, and partner status showed associations. Significant predictors included lower water intake (OR = 0.47, 95% CI: 0.33–0.65 for 1–1.5 L), artificial sweetener use (OR = 1.54, 95% CI: 1.13–2.11), moderate/high salt intake (OR = 1.45, 95% CI: 1.06–1.99), former/never smoking (OR = 2.56, 95% CI: 1.73–3.77), and heavy alcohol use (OR = 4.00, 95% CI: 1.33–12.50). Conclusions: Artificial sweetener use, high salt intake, smoking history, and heavy alcohol consumption are key modifiable predictors of overnutrition, informing targeted interventions for elderly Hungarians. Full article
(This article belongs to the Special Issue Addressing Malnutrition in the Aging Population)
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14 pages, 436 KiB  
Article
Validation and Reliability of the Polish Version of the Eating Assessment Tool-10 Questionnaire
by Barbara Jamroz, Magdalena Milewska, Aleksandra Ostrowska, Joanna Chmielewska-Walczak, Mariusz Panczyk and Dorota Szostak-Wegierek
Nutrients 2025, 17(8), 1291; https://doi.org/10.3390/nu17081291 - 8 Apr 2025
Viewed by 668
Abstract
Introduction: Early identification of patients at risk of dysphagia is of paramount importance. To date, no dysphagia screening questionnaire has been validated and translated into Polish that can be widely used in a multidisciplinary setting. Our study aimed to validate and adapt the [...] Read more.
Introduction: Early identification of patients at risk of dysphagia is of paramount importance. To date, no dysphagia screening questionnaire has been validated and translated into Polish that can be widely used in a multidisciplinary setting. Our study aimed to validate and adapt the Polish version of the Eating Assessment Tool-10 questionnaire (EAT-10). Materials and Methods: The EAT-10 questionnaire was translated into Polish using a formal forward–backward translation method. The Polish EAT-10 was administered to 109 patients with different dysphagia etiologies and 24 control subjects. Internal consistency, unidimensionality, test–retest reliability and external validity against the Visual Analog Scale (VAS), and Flexible Endoscopic Evaluation of Swallowing (FEES) were performed. Results: The EAT-10PL demonstrated excellent internal consistency (Cronbach’s α = 0.958) and confirmed unidimensionality. We found a strong correlation between EAT-10PL with the Visual Analog Scale (VAS) (rs = 0.94, p < 0.001) and a weaker correlation with the PAS (rs = 0.55, p < 0.001). We reported a sensitivity of 79.5% and specificity at the level of 60.0%, using ≥3 as a cut-off point. The statistically chosen cutoff point for PAS ≥ 2 and EAT-10 ≥ 6 indicated optimal specificity (70.0%) and sensitivity (79.5%) of measurements performed using EAT-10PL. The EAT-10PL questionnaire demonstrates high discriminatory ability relative to the control group (F(4, 104) = 16.219, p < 0.001, η2 = 0.38 [95%CI: 0.22–0.48]). Conclusions: The Polish EAT-10 is a valid and reliable, self-administered questionnaire for dysphagic patient identification. The Polish EAT-10 ≥ 3 can be considered abnormal; however, it seems that EAT-10PL is not appropriate for patients with dysphagia and a chronic cough background, and further research is required. Full article
(This article belongs to the Special Issue Addressing Malnutrition in the Aging Population)
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Review

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29 pages, 1209 KiB  
Review
The Oral–Gut Microbiota Axis as a Mediator of Frailty and Sarcopenia
by Domenico Azzolino, Margherita Carnevale-Schianca, Lucrezia Bottalico, Marica Colella, Alessia Felicetti, Simone Perna, Leonardo Terranova, Franklin Garcia-Godoy, Mariangela Rondanelli, Pier Carmine Passarelli and Tiziano Lucchi
Nutrients 2025, 17(15), 2408; https://doi.org/10.3390/nu17152408 - 23 Jul 2025
Abstract
Traditionally studied in isolation, the oral and gut microbiota are now being recognized as interconnected through anatomical and physiological pathways forming a dynamic “oral–gut microbiota axis”. Both oral and gut microbiota undergo changes with aging, characterized by a decline in microbial diversity and [...] Read more.
Traditionally studied in isolation, the oral and gut microbiota are now being recognized as interconnected through anatomical and physiological pathways forming a dynamic “oral–gut microbiota axis”. Both oral and gut microbiota undergo changes with aging, characterized by a decline in microbial diversity and a shift toward potentially harmful species. The aim of this review is, therefore, to provide an overview of oral–gut communications in mediating frailty and sarcopenia. PubMed, EMBASE and Scopus databases were searched for relevant articles. We limited our search to manuscripts published in the English language. Interactions between oral and gut microbiota occur mainly through three pathways namely the enteral, the bloodstream and the fecal-oral routes. Alterations in the oral–gut microbiota axis contribute to chronic low-grade inflammation (i.e., “inflamm-ageing”) and mitochondrial dysfunction, key mechanisms underlying frailty and sarcopenia. Microbial metabolites, such as short-chain fatty acids and modified bile acids, appear to play an emerging role in influencing microbial homeostasis and muscle metabolism. Furthermore, poor oral health associated with microbial dysbiosis may contribute to altered eating patterns that negatively impact gut microbiota eubiosis, further exacerbating muscle decline and the degree of frailty. Strategies aimed at modulating the microbiota, such as healthy dietary patterns with reduced consumption of ultra-processed foods, refined carbohydrates and alcohol, ensuring an adequate protein intake combined with physical exercise, as well as supplementation with prebiotics, probiotics, and omega-3 polyunsaturated fatty acids, are increasingly recognized as promising interventions to improve both oral and gut microbiota health, with beneficial effects on frailty and sarcopenia. A better understanding of the oral–gut microbiota axis offers promising insights into nutritional interventions and therapeutic strategies for the age-related muscle decline, frailty and systemic health maintenance. Full article
(This article belongs to the Special Issue Addressing Malnutrition in the Aging Population)
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Other

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15 pages, 2092 KiB  
Systematic Review
Non-Severe Hypophosphatemia in Older Patients: A Systematic Review
by Luca Barbarossa, Martina Zandonà, Maria Luisa Garo, Ribal Bou Mjahed and Patrizia D’Amelio
Nutrients 2025, 17(8), 1354; https://doi.org/10.3390/nu17081354 - 16 Apr 2025
Viewed by 965
Abstract
Background/Objectives: Phosphorus plays a fundamental role in cellular and extracellular metabolism, contributing to nucleic acid synthesis, enzymatic activity, neurologic function, and skeletal mineralization. Despite its significance, non-severe hypophosphatemia (HP) remains largely asymptomatic and underdiagnosed, with limited data on its prevalence in the general [...] Read more.
Background/Objectives: Phosphorus plays a fundamental role in cellular and extracellular metabolism, contributing to nucleic acid synthesis, enzymatic activity, neurologic function, and skeletal mineralization. Despite its significance, non-severe hypophosphatemia (HP) remains largely asymptomatic and underdiagnosed, with limited data on its prevalence in the general population. Most studies focus on specific subgroups, such as critically ill or dialysis patients, while the impact of mild HP in older adults, a potentially vulnerable demographic, is not well understood. The objective of this systematic review is to investigate the prevalence and clinical implications of non-severe HP in older adults. Methods: The study followed PRISMA guidelines to assess HP in patients aged ≥ 65 years without critical illnesses or genetic disorders. A systematic search was conducted in PubMed, Web of Science, and Scopus (March 2024). Eligible studies included RCTs and prospective/retrospective studies, excluding cancer-related studies or insufficient phosphate data. Results: We identified 1350 articles, with 26 meeting eligibility criteria. Ultimately, eight studies involving 26,548 patients were included, with an HP prevalence of 12.5%. Studies reveal a higher prevalence of HP in frail individuals, particularly those with increased frailty scores, and an association between HP and cognitive decline, depressed mood, falls, and chronic comorbidities. HP was also prevalent in infectious diseases, especially bacterial pneumonia, with longer hospital stays and increased mortality rates. Malnutrition was significantly more common in HP patients, characterized by weight loss and poor nutritional status. Furthermore, HP increased fall risk during hospitalization and worsened outcomes after coronary artery bypass graft surgery, including higher mortality and graft failure rates, underscoring its clinical importance. Discussion: This review identified that non-severe hypophosphatemia (HP) is associated with conditions such as frailty, cognitive decline, and an increased risk of falls. The evidence suggests that low phosphate levels may negatively impact health, increasing mortality and the risk of adverse clinical outcomes. Despite limitations in diagnostic criteria and sample variability, the findings indicate that HP can be a useful marker for identifying patients at risk of health deterioration. Further research is needed to clearly define the management and treatment of HP in this vulnerable population. Full article
(This article belongs to the Special Issue Addressing Malnutrition in the Aging Population)
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