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As people age, maintaining good nutritional status becomes an increasingly complex challenge. Malnutrition, sarcopenia, and sarcopenic obesity are interrelated conditions that can seriously affect quality of life, independence, and overall health.

This guide, produced by Sapienza University of Rome and the University of Pavia within the TM-SO and SENIOR research projects, was developed under OnFoods Spoke 6, which focuses on malnutrition in vulnerable populations and the promotion of sustainable nutritional strategies.

The TM-SO project (Tackling Malnutrition and Sarcopenic Obesity) investigates the close relationship between malnutrition, muscle loss (sarcopenia), and obesity—conditions that often reinforce one another, creating a vicious cycle of reduced mobility, disability, and frailty.

Through a multidimensional approach, TM-SO profiles individuals with sarcopenic obesity, examining dietary habits, socioeconomic factors, and gut microbiota to develop and validate sustainable nutritional strategies, biomarkers, and functional foods for prevention and treatment.

The SENIOR project (Sustainable Eating Patterns to Limit Malnutrition in Older Adults) addresses the growing issue of malnutrition among adults over 65, which affects health and independence.

In collaboration with ICS Maugeri and Policlinico San Matteo in Pavia, the research team assesses the nutritional status of more than 200 participants, analysing anthropometric parameters, lifestyle habits, and socio-demographic factors.

Based on these results, SENIOR is developing new sustainable and personalised nutritional protocols to prevent sarcopenia and improve older adults’ quality of life.

Understanding the three conditions

• Malnutrition: may occur due to deficiency (lack of protein, energy, vitamins, and minerals) or excess (overweight and obesity). It is often exacerbated by age-related physiological and social factors such as loss of appetite, loneliness, or financial hardship
• Sarcopenia: a progressive loss of muscle mass and strength that increases the risk of falls, fractures, and loss of independence
• Sarcopenic obesity: combines low muscle mass with excess body fat and fat infiltration in the muscles, worsening both physical and cognitive frailty

Main risk factors

The causes are multifactorial and often interconnected:

• Clinical and functional: loss of appetite or senses (taste, smell, sight); chewing or swallowing difficulties; limited mobility; acute or chronic diseases that alter energy or nutrient needs; polypharmacy; food intolerances
• Psychological: depression, cognitive decline, loss of motivation
• Social and economic: isolation, lack of family support, limited financial resources
• Dietary: monotonous or restrictive diets, low protein intake, alcohol abuse

How to intervene

Addressing these conditions requires an integrated approach combining personalised nutritional interventions, regular physical activity, and social support:

• Dietetic counselling to define an individualised nutrition plan
• High-energy, high-protein diet, with possible use of oral nutritional supplements (ONS)
• Aerobic, resistance, and balance exercises to preserve muscle mass
• Shared mealtimes to reduce loneliness and stimulate appetite

The ultimate goal: to promote healthy ageing by maintaining strength, autonomy, and physical and mental wellbeing.

After exploring the effects of malnutrition in adults, attention turns to childhood, a critical period in which an imbalance between nutritional needs and intake can impair growth, development, and long-term health.

Malnutrition occurs when nutrient intake does not meet the body’s needs and can take the form of both deficiency (underweight, stunted growth) and excess (overweight, obesity). Both represent major public health issues, particularly when they develop early in life.

The team at the University of Naples Federico II—comprising dietitians, doctors, nurses, biologists, microbiologists, and biostatisticians—investigates the risk factors of childhood malnutrition to develop sustainable strategies to combat it. The DAMATO and NAOM projects address overnutrition and its metabolic consequences through a multidisciplinary approach.

DAMATO (Dietary habits and gut microbiome as a target of sustainable intervention against obesity) studies the role of the gut microbiome and dietary habits, particularly the consumption of ultra-processed foods and cooking-derived compounds (AGEs), in the development of obesity and metabolic syndrome in both children and adults.
Its goal is to develop sustainable, personalised nutritional strategies, including the creation of a predictive algorithm and an educational app to promote healthier eating choices.

NAOM (New therapeutic approach against obesity and metabolic diseases) explores innovative nutritional and therapeutic interventions against obesity and metabolic disorders.
The aim is to pave the way for sustainable strategies to prevent and treat these conditions, with tangible benefits for patients, families, and the healthcare system.

Prevention tips

• Choose fresh, natural foods
• Prepare meals at home using simple ingredients
• Read food labels and avoid products high in additives and sugars
• Limit packaged snacks and fast food
• Prefer water, herbal teas, or natural juices to sugary drinks

A balanced diet based on minimally processed foods is the first step towards preventing malnutrition and metabolic diseases from early childhood.

OnFoods Spoke 6 addresses malnutrition in IBD patients through the research project IBD-ONFOODS (A Multidimensional Assessment for Tackling Malnutrition in Inflammatory Bowel Disease), led by the University of Pavia. Researchers are working to define sustainable and personalised nutritional strategies to prevent malnutrition and reduce complications associated with IBD.

Inflammatory bowel diseases such as Crohn’s disease and ulcerative colitis are complex, relapsing conditions that alternate periods of remission with flare-ups.
Beyond gastrointestinal symptoms, they can cause significant nutritional complications, affecting patients’ wellbeing and quality of life.

In IBD patients, malnutrition may result from multiple factors: reduced intestinal absorption, nutrient loss, chronic inflammation, poor appetite, abdominal pain, and frequent hospitalisation.

Unbalanced diets can lead to macro- and micronutrient deficiencies (including iron, calcium, zinc, and vitamins A, D, E, K, B9, and B12), causing both underweight and overweight/obesity.

Over time, these conditions increase the risk of sarcopenia (loss of muscle mass and strength) and osteoporosis, often due to low calcium intake and impaired vitamin D synthesis.

Managing malnutrition in IBD patients

Given the clinical complexity of these diseases, personalised dietetic counselling is essential to design an appropriate nutritional plan.

In case of weight or strength loss:

• Eat small, frequent meals to improve gastrointestinal tolerance
• Add high-calorie foods (olive oil, nuts, aged cheese)
• Include lean protein sources (fish, poultry, low-fat dairy) at each meal
• Stay well hydrated as per medical advice
• Consider oral nutritional supplements (ONS) if necessary

In case of diarrhoea:

• Reduce foods high in fibre, fat, lactose, and simple sugars
• Avoid fried foods, sweets, fizzy drinks, and industrial juices
• Use MCT oil (medium-chain triglycerides) if recommended
• Maintain good hydration to replace fluid losses

In case of overweight or obesity:

• Excess body weight can worsen IBD and lead to poorer clinical outcomes
• A tailored dietary plan is recommended to restore optimal nutritional status