Malnutrition- Nutrition to support unintentional weight loss

Malnutrition

Malnutrition - Weight Gain Therapy

Manage Malnutrition and unintentional weight loss with medical nutrition therapy (MNT)

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What is Malnutrition?

Malnutrition occurs when an individual does not meet their nutrition requirements and leads to noticeable and measurable symptoms.
These symptoms can include but are not limited to:
– Rapid weight loss
– Fatigue and confusion
– Reduced strength
– Increased risk of infection and disease
– Decreased rate of healing and lower healing potential
– Hair loss, nail brittleness and skin fragility
– Increased risk of falls

Malnourished hands, low body weght, elderly, frail, low muscle, low strength

What causes malnutrition?

There are 2 primary concern groups of malnutrition

1. Energy and protein deficiencies (macronutrients)

All food contains chemical energy (kJ or Cal). We all need energy to survive and thrive.

When we don’t get enough energy through food, the body will start breaking down its stored energy, typically adipose/ fat tissue, then muscle and finally organs.

The lower the energy we consume and the faster we lose weight, the more muscle and organ tissue we lose. This can be very bad for health.

2. Micronutrients deficiencies (vitamin, mineral and phytonutrient)

These are nutrients we need in smaller amounts compared to energy and macronutrients.

Vitamins and Minerals are usually found in abundance in whole foods. When we don’t consume enough whole foods, we can be specifically nutrient-deficient, which may stop certain parts of our bodies from working the way they are meant to.

Usually, when you are energy and protein deficient, you have a much higher risk of micronutrient deficiency.

Frail, weak leaves representing weaker people from unintentional weight loss or malnutrition

Consequences of Malnutrition

Malnutrition is more than just a number dropping on the scales; it initiates a cascade of systemic issues that compromise your physical independence and metabolic function. When the body lacks adequate fuel and protein, it begins to consume its own functional tissues to survive. The primary consequences include:

  • Severe Muscle Wasting (Sarcopenia): As the body breaks down skeletal muscle for energy, you lose the physical strength required for daily tasks, significantly increasing the risk of debilitating falls and fractures.

  • Impaired Surgical and Trauma Recovery: Proper nutrition is the foundation of cellular repair. Malnutrition dramatically stalls wound healing and reduces the body’s ability to recover from high-acuity events, such as cardiothoracic surgery, neurosurgery, or major orthopedic trauma.

  • Compromised Immunity: A lack of essential micronutrients and protein impairs the production of immune cells, leaving you highly susceptible to severe infections and chest complications.

  • Loss of Independence: The compounding effects of fatigue, reduced healing, and weakness often lead to longer hospital stays, higher readmission rates, and a devastating loss of physical autonomy.

What we can do

How is Malnutrition diagnosed?

Accurately diagnosing malnutrition requires far more than simply calculating a Body Mass Index (BMI) or stepping on a scale. At REAL Health & Nutrition, our Accredited Practising Dietitians utilize internationally recognized clinical frameworks to identify not just if you are malnourished, but why it is happening and how severe it is.

The GLIM Criteria (The Global Standard) We utilize the Global Leadership Initiative on Malnutrition (GLIM) criteria, the international gold standard for diagnosis. To confirm a diagnosis under GLIM, we look for a combination of two specific types of indicators:

  • Phenotypic (Physical) Criteria: Unintentional weight loss, a low BMI, or a measurable reduction in muscle mass and physical strength (sarcopenia).

  • Etiologic (Cause-Based) Criteria: Significantly reduced food intake, poor nutrient absorption (such as severe gastrointestinal issues), or a high disease burden/inflammatory state caused by acute illness, surgery, or chronic co

Understanding HAM vs CAM

In the Australian healthcare system, malnutrition is also clinically categorised based on where and how it originated.

This helps us tailor the most effective medical nutrition therapy for your recovery:

Community-Acquired Malnutrition (CAM):

Elderly person at their home with community acquired malnutrition (CAM). Photo by Triet Bui on Unsplash

This develops gradually at home. It is often driven by chronic disease, a slow decline in appetite, or difficulty preparing meals.

Identifying CAM early in the clinic is critical to preventing falls, protecting your immune system, and avoiding hospital admissions.

Hospital-Acquired Malnutrition (HAM):

Elderly person at their home with hospital acquired malnutrition (HAM). Photo by Kim Ui Jin on Unsplash

This occurs rapidly during a hospital stay. It is typically the result of the body’s massive energy demands during surgical stress or trauma, combined with prolonged periods of fasting for medical procedures.

If you have recently been discharged with HAM, immediate nutritional rehabilitation is essential to heal wounds and prevent readmission.

How is Malnutrition treated?

To stop immediate further weight loss and loss of function, a Dietitian (APD) may place you on a high-energy, high-protein (HEHP) diet.

This diet is designed to dramatically increase your available energy (kJ and Cal) and protein to support maintaining your muscles and strength, and allow your body to function normally.
Your Dietitian may recommend a specific dietary strategy tailored to your preferences to increase rates of success and further support your health goals.

Specific supplements, “energy and protein supplements” (more commonly known as Fortisip/ Ensure/ Sustagen) may be recommended.
It is important to note that no matter how much protein you eat, if you don’t use your body, it will continue to reduce in function.
The saying “you lose it, or you lose it” is very true in this scenario.

How common Malnutrition?

Malnutrition is a silent epidemic within the Australian healthcare system. Clinical data indicate that between 30% and 50% of patients admitted to Australian hospitals are either malnourished or at a high clinical risk of malnutrition upon admission.

Disturbingly, this condition frequently goes unnoticed in the community until an acute medical event, such as a major fall, a cardiac episode, or a trauma admission, forces a hospital stay. Patients who enter the hospital in a malnourished state face a significantly uphill battle; their length of stay is typically extended, and their risk of mortality and complications is notably higher. 

Identifying and intervening with targeted medical nutrition therapy in the community is a critical, literal lifesaver that prevents these severe hospital admissions.

When should you see a Dietitian for Malnutrition or weight loss?

We recommend seeing a dietitian if you:

  • Have signs and symptoms of malnutrition
  • Are worried about whether you are deficient in specific nutrients
  • Would like advice on the prevention, identification or treatment of malnutrition.
  • Experience loss of appetite or sudden weight changes

Accredited Practising Dietitians (APDs) are university-trained nutrition experts.

They can help you with personalised, easy-to-follow and evidence-based advice.

Why Choose REAL for Supporting Your Weight?

At REAL Health & Nutrition, we believe that restoring your weight and rebuilding your strength shouldn’t come at the cost of enjoying your meals.

Our Accredited Practising Dietitians (APD) use compassionate, evidence-based Medical Nutrition Therapy to help you regain your energy, preserve your vital muscle mass, and feel resilient and in control of your body again.

Realistic nutrition solutions

REAL Health & Nutrition was founded in Melbourne by Matthew Rigoni alongside a passionate team that provides evidence-based nutrition strategies that fit into your life.

Our diverse clientele includes individuals seeking to manage chronic disease, enhance their energy, and those aiming to improve their healthspan and longevity through sustainable health and nutrition strategies.

Matthew Rigoni, expert Dietitian and sports dietitian- REAL Health & Nutrition

Practitioners

Meet the team

Highly skilled and qualified Dietitians and Sport Nutritionists

  • Matthew Rigoni Accredited Practising Dietitian (APD), sport Nutritionist, Accredited Sport Dietitian (ASD)

    Matthew Rigoni

    Head Dietitian (APD) & Sports Nutritionist

    Matthew Rigoni is an Accredited Practising Dietitian and Sports Nutritionist supporting clients across Eltham, Diamond Creek and Melbourne’s North-East. He specialises in weight management, chronic disease care, IBS/low-FODMAP nutrition, and sports-performance nutrition. His approach focuses on evidence-based, realistic strategies tailored to each client’s health goals. Matthew also brings experience in strength training and rehabilitation, helping clients build long-term, sustainable habits.

  • Max Dennehy Dietitian, body building coach

    Max Dennehy

    Dietitian and Bodybuilding Coach

    Max Dennehy is a qualified Dietitian with strong expertise in sports nutrition, weight loss, muscle gain and body recomposition. He has more than seven years of hands-on experience in bodybuilding and strength training, blending clinical nutrition with practical performance coaching. Max supports clients managing chronic conditions, improving metabolic health, and achieving body-composition goals. His coaching style is structured and supportive, helping clients stay consistent and confident.

  • Emma Westlake Accredited Sports Nutritionist

    Emma Westlake

    Accredited Sports Nutritionist

    Emma Westlake is a Nutritionist and Accredited Sports Nutritionist with experience in athletic performance, endurance nutrition, injury recovery and rehabilitation. She brings a strong background in Biomedical Science and works with clients to improve energy, health and long-term wellbeing. Emma has supported athletes across AFL/AFLW, triathlon and running communities, offering clear and practical guidance. Her passion lies in helping active individuals optimise performance through personalised, evidence-based nutrition.

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Frequently Asked Malnutrition Questions

Questions for unintentional weight loss & Malnutrition

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    Yes, malnutrition is specifically a state of being, over a specific time.

    If we use heart attack patients as an example, getting them to lose weight rapidly after a heart attack can often lead to reduced healing of the heart.

    People who are bigger are at a higher risk of going undiagnosed and can have a higher rate of muscle loss before a Dietitian is referred or notified.

    Multivitamins serve a purpose, this is not one of them.

    General multivitamins do not supply appropriate energy and protein to the body and only support some (not all) micronutrients that are needed.

    No, majority of the time it is the worst time to lose weight.

    While weight loss may be a part of a general health goal, when you are not your normal self it is even more difficult to control weight.

    This can lead to an even harder time achieving long term weight goals as often in malnutrition we lose too much muscle mass, reducing our metabolism and metabolic health.

    While appetite and metabolism can naturally decrease as we age, rapid or unintentional weight loss is never something to just accept as “normal ageing.”

    A shrinking appetite often leads to a dangerous loss of muscle mass (known as sarcopenia). This muscle loss directly increases the risk of falls, frailty, and losing physical independence.

    We help maximise the nutrition in smaller meals so older adults can maintain their strength without feeling forced to eat huge, overwhelming portions.

    Not necessarily. While medical nutrition supplements (like Sustagen or Ensure) can be helpful safety nets in severe cases, our primary approach is always “food-first.”

    We prefer to teach you how to seamlessly fortify the everyday meals you already enjoy, like soups, porridge, or smoothies, with extra energy and high-quality protein.

    We want you enjoying real food, not just relying on artificial shakes.

    The most obvious sign is unintentional weight loss, which you might notice if their clothes, rings, or dentures suddenly seem loose.

    However, other early red flags include feeling constantly exhausted, taking much longer than usual to recover from simple colds or wounds, a noticeable drop in physical strength (like struggling to stand up from a chair), and a sudden disinterest in foods they used to love.

    Absolutely. Your body’s energy and protein demands skyrocket during the healing process, especially following high-acuity procedures like cardiothoracic, neurosurgical, or orthopedic operations.

    Even if you were a healthy weight prior to surgery, the combination of a surgical stress response, fasting for procedures, and a loss of appetite can rapidly trigger acute malnutrition.

    Surgery and hospital admission-related weight loss is not a good thing

    Targeted nutrition therapy is essential to rebuild tissue and ensure your rehabilitation is successful.

    Yes. Transitioning from a high-care hospital ward back to your home with a feeding tube can be overwhelming. We provide expert management of enteral nutrition, ensuring your feeding regimen meets your precise metabolic requirements, prevents gastrointestinal upset, and is adjusted safely as your ability to eat whole foods improves.

    We do not just look at your BMI. Dietitians use comprehensive clinical tools, such as the Subjective Global Assessment (SGA).

    This involves a detailed look at your recent weight history, changes in your dietary intake, gastrointestinal symptoms, and a physical assessment to detect subtle fat and muscle wasting around your temples, collarbones, and hands.

    Significantly. Whether it is a surgical incision, a trauma wound, or a pressure injury, your body requires massive amounts of specific macronutrients (protein) and micronutrients (like Zinc and Vitamin C) to synthesize new tissue and collagen. 

    Without this fuel, wounds can stagnate, break down, or become chronically infected.We do not just look at your BMI. Dietitians use comprehensive clinical tools, such as the Subjective Global Assessment (SGA).

    This involves a detailed look at your recent weight history, changes in your dietary intake, gastrointestinal symptoms, and a physical assessment to detect subtle fat and muscle wasting around your temples, collarbones, and hands.

    It is rarely too late. While reversing muscle wasting (sarcopenia) takes consistency, combining a high-energy, high-protein clinical diet with appropriate physical rehabilitation can successfully rebuild functional muscle.

    Our primary goal is to stabilise your weight first, and then strategically fuel your body to restore your strength, healthspan, and vitality.

Extra reading

Dietitians Australia. (2022). Malnutrition in the Australian Context: Evidence-Based Practice Guidelines. The definitive framework for Australian health professionals detailing the identification, diagnosis, and medical nutrition therapy protocols for managing malnutrition across hospital and community settings. https://dietitiansaustralia.org.au/health-advice/malnutritionhttps://dietitiansaustralia.org.au/

Australian Commission on Safety and Quality in Health Care (ACSQHC). (2021). Comprehensive Care Standard: Malnutrition. National healthcare standards outlining the profound clinical and economic impact of hospital-acquired malnutrition and the critical need for routine screening. https://www.safetyandquality.gov.au/standards/nsqhs-standards/comprehensive-care-standard

Cederholm, T., et al. (2019). GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report. Clinical Nutrition, 38(1), 1-9. The global clinical consensus establishing the standardized criteria for diagnosing malnutrition, focusing on unintentional weight loss, low body mass index, and reduced muscle mass. https://doi.org/10.1016/j.clnu.2018.08.002