Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Jun;38(1):219-228.
doi: 10.1017/S095442242400012X. Epub 2024 Apr 5.

Challenges in identifying malnutrition in obesity; An overview of the state of the art and directions for future research

Natasha Nalucha Mwala  1   2 , Jos W Borkent  1   2 , Barbara S van der Meij  1   2   3 , Marian A E de van der Schueren  1   2
Affiliations
Review

Challenges in identifying malnutrition in obesity; An overview of the state of the art and directions for future research

Natasha Nalucha Mwala et al. Nutr Res Rev. 2025 Jun.

Abstract

(Protein-energy) malnutrition in individuals living with obesity presents complex diagnostic challenges due to the distinctive physiological characteristics of obesity. This narrative review critically examines the identification of malnutrition within the population with obesity, distinguishing malnutrition in obesity from related conditions such as sarcopenic obesity. While noting some shared features, the review highlights key differences between these conditions. The review also highlights the limitations of current malnutrition screening tools, which are not designed for individuals living with obesity. These tools primarily rely on anthropometric measurements, neglecting (among others) nutrient intake assessment, which hinders accurate malnutrition detection. Additionally, this review discusses limitations in existing diagnostic criteria, including the Global Leadership Initiative on Malnutrition (GLIM) criteria, when applied to individuals living with obesity. Challenges include the identification of appropriate cut-off values for phenotypic criteria (unintentional weight loss, low body mass index and muscle mass) and aetiological criteria such as reduced food intake and inflammation for the population with obesity. Overall, this review emphasises the need for modified screening tools and diagnostic criteria to recognise and assess malnutrition in obesity, leading to improved clinical outcomes and overall wellbeing.

Keywords: GLIM; double burden; malnutrition; obesity; sarcopenic obesity; screening tool.

PubMed Disclaimer

Conflict of interest statement

Competing interests

The author(s) declare none.

Figures

Fig. 1
Fig. 1. Differences and similarities of sarcopenic obesity and malnutrition in obesity.
See this image and copyright information in PMC

References

    1. Schuetz P, Seres D, Lobo DN, et al. Management of disease-related malnutrition for patients being treated in hospital. Lancet. 2021;398:1927–1938. - PubMed
    1. Kruizenga H, van Keeken S, Weijs P, et al. Undernutrition screening survey in 564,063 patients: patients with a positive undernutrition screening score stay in hospital 1.4 d longer. Am J Clin Nutr. 2016;103:1026–1032. - PubMed
    1. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8:514–527. doi: 10.3390/ijerph8020514. - DOI - PMC - PubMed
    1. Freijer K, Tan SS, Koopmanschap MA, et al. The economic costs of disease related malnutrition. Clin Nutr. 2013;32:136–141. - PubMed
    1. Meijers JMM, Halfens RJG, van Bokhorst-de van der Schueren MAE, et al. Malnutrition in Dutch health care: prevalence, prevention, treatment, and quality indicators. Nutrition. 2009;25:512–519. - PubMed