How disease related malnutrition can link to physical frailty in older people

Addressing malnutrition and frailty

Today, the world is experiencing unprecedented demographic change, with the number of people over the age of 65 exceeding the number of children under the age of 5 for the first time in history. This trend, which is partly due to declining birth rates worldwide, is mainly associated with advances in healthcare, medical science and nutrition that are contributing to longer life expectancy.

But while a longer life expectancy is a good thing, increasing this life expectancy in GOOD HEALTH is not always guaranteed. Common problems such as cardiovascular disease, diabetes, obesity and seasonal viruses have a greater impact on the elderly than on younger people. These problems often result in difficulties in eating properly, which in turn leads to other problems such as frailty syndrome (which we will simply refer to as frailty hereafter). This gradually and inadvertently creates a vicious circle that erodes mobility, independence and quality of life over time and promotes the onset of increasingly disabling diseases.

At Danone Research and Innovation , we develop solutions to address malnutrition and combat its harmful effects on older populations.

A quick overview of malnutrition among the elderly

Malnutrition among older adults is a multifaceted issue that significantly impacts their health, quality of life, and independence. It is an imbalance between the body's nutritional needs and the intake of vital nutrients, including proteins, vitamins, and minerals. This imbalance can manifest as undernutrition, micronutrient deficiencies, or even overnutrition in cases where caloric intake is sufficient but lacks essential nutrients.

Global malnutrition in the elderly

Globally, serious deficiencies affect approximately one-quarter of the elderly, with the prevalence of malnutrition varying across healthcare settings. And this is even worse in clinical settings. Studies indicate that malnutrition rates range from 12% to 50% among hospitalized older individuals and from 23% to 60% among those in long-term care facilities¹. Despite advancements in healthcare, the absolute number of malnourished older adults continues to rise due to demographic aging and increasing life expectancy².

Causes of malnutrition in older adults

Malnutrition in older people is often rooted in:

Physiological factors: reduced appetite, difficulty chewing or swallowing, digestive issues, and alterations in taste perception make eating less appealing or physically challenging.
Chronic diseases: conditions such as diabetes, cardiovascular diseases, cancer , and neurodegenerative disorders increase nutrient requirements while impairing absorption³.
Psychosocial issues: depression, social isolation, and economic constraints limit access to nutritious food and reduce motivation for meal preparation.
Hospitalization and medications: prolonged hospital stays and certain medications can suppress appetite or interfere with nutrient metabolism¹.

Consequences of malnutrition

The effects of malnutrition are far-reaching:

Physical Decline: loss of muscle mass (sarcopenia), increased frailty, and higher risk of falls and fractures are common outcomes⁴.
Immune deficiency: malnutrition weakens immune function, heightening susceptibility to infections and delaying recovery from illnesses¹.
Cognitive impairment: nutritional deficiencies are closely linked to cognitive decline and depression, further exacerbating health issues⁴.
Economic burden: malnutrition increases healthcare costs due to longer hospital stays, frequent re-hospitalizations, and greater reliance on long-term care facilities¹.

A large-scale problem

Despite efforts to reduce malnutrition rates globally, the burden remains high. In 2021 alone, over 97.6 million cases of malnutrition were reported among older adults, a 1.2-fold increase since 1990². While malnutrition is often associated with low socio-economic development regions, its prevalence is also rising in high-income countries due to complex health needs and lifestyle changes².

The links between frailty and malnutrition in older people

Frailty and malnutrition are deeply interconnected conditions that often coexist among older adults. Malnutrition exacerbates frailty status by accelerating muscle loss (sarcopenia), reducing physical strength, impairing immune function , and increasing vulnerability to infections or injuries. Conversely, frailty contributes to malnutrition by limiting mobility in activities of daily living, reducing appetite due to fatigue or illness-related discomforts, and increasing dependency on caregivers for nutritional needs.

This cyclical relationship creates a downward spiral where both conditions reinforce each other. Moreover, research highlights that individuals with severe frailty often exhibit chronic inflammation, a condition linked to nutrient deficiencies, and experience significant declines in physical performance over time⁴. Socioeconomic factors such as poverty or social isolation further compound these risks⁵.

The consequences of frailty on the quality of life

They are very similar to the consequences of malnutrition, but their impact is felt more on the social level than from a strictly metabolic, physical or psychological point of view.

Thus, frailty profoundly impacts multiple aspects of an individual's quality of life. For example:

Reduced mobility prevents older adults from engaging in daily activities like walking, cooking independently or playing with their grandchildren.
Frailty increases feelings of helplessness or depression while diminishing self-confidence.
Fear of falling or worsening health conditions often leads individuals to withdraw socially.
Managing frailty-related complications imposes significant financial costs on families and healthcare systems alike.

These consequences highlight why addressing the malnutrition-frailty vicious circle early is crucial for preserving autonomy and well-being among aging populations.

Danone's comprehensive approach to frailty and malnutrition prevention and management

Our holistic approach to nutrition

Effective interventions to prevent the risk of malnutrition and frailty in older adults go beyond simply increasing caloric intake. They require a comprehensive approach that includes nutrients like high-quality protein sources, essential vitamins or minerals, all tailored specifically toward elderly populations' unique needs.

At Danone, through our Nutricia medical nutrition division, we are actively engaged in developing evidence-based interventions to support healthy aging and improve quality of life for older patients at risk of disease-related malnutrition (DRM) and physical frailty.

Key aspects include:

Protein intake optimization: consuming enough protein, particularly from leucine-rich foods like dairy, are crucial for stimulating muscle protein synthesis and preserving muscle mass. This is essential for preventing sarcopenia, a major contributor to frailty.
Micronutrient support: vitamins D and B12, along with antioxidants, play a vital role in maintaining muscle function, cognitive health, and overall resilience. These nutrients help reduce inflammation and support physical performance.
Targeted nutritional interventions: we develop specialized nutritional products under medical supervision to address specific challenges such as insufficient energy intake or difficulty swallowing.

Learn more about our specialized nutrition products here.

Innovative solutions based on the latest scientific advances

Our commitment to research ensure that our food for elderly special needs are grounded in scientific evidence. We collaborate with healthcare professionals, researchers, and industry experts to explore breakthrough ways to address malnutrition and frailty. This includes:

Gut microbiome research: we understand the essential role of the gut microbiota in the absorption of nutrients. But we also know that the bacterias of the gut flora become less effective with age. By enriching our products with biotics, we support the intestinal health of older people and optimize the effectiveness of nutritional interventions.
Sustainability: we are seeking to develop plant-based protein alternatives because, when they are well balanced, they can completely replace animal proteins while also being part of environmentally sustainable practices.
Early prevention: malnutrition is not necessarily inevitable. If you know how to prevent it in time. That's why we believe in the power of food education from the earliest age. Because children and adults who know how to eat will make healthy seniors. With this in mind, we develop nutrition education programs that we tailor to the world's different populations, according to their needs, habits and resources.

We stand by the medical community

Our collaborative approach ensures that we remain at the forefront of innovation, translating scientific discoveries into practical solutions that can be implemented in clinical settings and everyday life. By fostering partnerships with healthcare professionals, academic researchers, and industry experts, we continue to shape the future of nutrition for frailty management, always striving for better patient outcomes and improved quality of life.

At Danone R&I, our dedication to advancing science-based nutrition ensures that we continue to make meaningful progress in the fight against frailty and malnutrition. By developing nutritional solutions that address the underlying causes of frailty, we aim to empower individuals to maintain their independence, enhance their resilience, and enjoy a higher quality of life.

Evans C. Malnutrition in the elderly: a multifactorial failure to thrive. Perm J. 2005 Summer;9(3):38-41. doi: 10.7812/TPP/05-056. PMID: 22811627; PMCID: PMC3396084.
Li Le , Liu Xiao , Fang Yujie , Guo Kailin , Li Lu , Cai Shuhan , Hu Chang , Hu Bo. Global patterns of change in the burden of malnutrition in older adults from 1990 to 2021 and the forecast for the next 25 years. Frontiers in Nutrition. DOI=10.3389/fnut.2025.1562536. ISSN=2296-861X
Dent E, Wright ORL, Woo J, Hoogendijk EO. Malnutrition in older adults. Lancet. 2023 Mar 18;401(10380):951-966. doi: 10.1016/S0140-6736(22)02612-5. Epub 2023 Jan 27. PMID: 36716756.
Norman K, Haß U, Pirlich M. Malnutrition in Older Adults-Recent Advances and Remaining Challenges. Nutrients. 2021 Aug 12;13(8):2764. doi: 10.3390/nu13082764. PMID: 34444924; PMCID: PMC8399049.
Lu W-H, Giudici KV, Rolland Y, Guyonnet S, Mangin J-F, Vellas B and de Souto Barreto P (2021) Associations Between Nutritional Deficits and Physical Performance in Community-Dwelling Older Adults. Front. Nutr. 8:771470. doi: 10.3389/fnut.2021.771470
Hoogendijk EO, Flores Ruano T, Martínez-Reig M, López-Utiel M, Lozoya-Moreno S, Dent E, Abizanda P. Socioeconomic Position and Malnutrition among Older Adults: Results from the FRADEA Study. J Nutr Health Aging. 2018;22(9):1086-1091. doi: 10.1007/s12603-018-1061-1. PMID: 30379307; PMCID: PMC6302545.