Is It Really a Problem of Undernutrition? An Analysis of the Consequences

Malnutrition represents a multifaceted pathophysiological condition characterized by chronic or acute deficiencies in essential macronutrients and micronutrients—including complete proteins, essential fatty acids, complex carbohydrates, fat-soluble and water-soluble vitamins, electrolytes, and trace elements. The cumulative effect of these deficiencies leads to progressive impairment of homeostatic regulatory mechanisms, resulting in metabolic dysfunction, compromised immune response, and tissue degradation. According to the latest guidelines from the European Society for Clinical Nutrition and Metabolism (ESPEN), a diagnosis of malnutrition requires meeting at least one of two primary criteria: (1) a body mass index (BMI) below the threshold of 18.5 kg/m² or (2) unintentional weight loss exceeding 10% regardless of the observation period or 5% over the preceding three months—while simultaneously considering age-specific BMI thresholds (20 kg/m² for individuals under 70 years of age and 22 kg/m² for those over 70) or a reduced fat-free mass index (FFMI < 15 kg/m² in women and < 17 kg/m² in men). Additional diagnostic indicators include decreased serum albumin levels (< 3.5 g/dL), clinical manifestations of nutritional dystrophy, and substantial weight loss (≥5% within one month or ≥10% over a 3–6 month period). Since 2012, mandatory nutritional screening for all hospitalized patients (excluding emergency admissions) has become standard practice, utilizing validated tools such as the Nutritional Risk Screening 2002 (NRS-2002) or the Subjective Global Assessment (SGA). Extended diagnostics may incorporate a comprehensive dietary history, anthropometric measurements, physical performance evaluations, and laboratory analyses of key biochemical parameters (including transferrin and prealbumin). Malnutrition is a worldwide concern affecting populations irrespective of age or geographic location, with particularly severe prevalence in regions experiencing economic downturns and social instability.