The German Society for Nutritional Medicine (DGEM) estimates the extent of malnutrition and its consequences in Germany at about 50,000 deaths annually. In other words: It is possible for fifty thousand people to live longer if they were able to obtain and benefit from the nutrients they lack. The problem here is that malnutrition does not appear in most cases except when its consequences have become serious.
Regarding this, Matthias Perlich, a doctor specializing in nutrition and internal medicine and former vice president of the German Society for Nutritional Medicine, says: “In most cases, the person does not notice anything at first. You may have had a severe vitamin D deficiency for months or even longer before any symptoms appeared. This also applies to vitamin B12. And when symptoms appear, such as nerve damage, it is already too late.”
For example, prolonged vitamin B12 deficiency can lead to damage to the spinal cord, which may result in numbness in the extremities, muscle weakness, or even symptoms of paralysis. In less common cases, brain damage occurs and leads to memory disorders and psychological problems.
What is “malnutrition” and what does “undernutrition” mean?
All B vitamins are essential for metabolism, blood formation, and nerve health. Vitamins, along with various minerals such as calcium, magnesium, iron, iodine, and zinc, are micronutrients that the body cannot produce itself, but must obtain through food.
In order for the body to get enough nutrients, we need micronutrients just as we need the basic nutrients that provide us with energy, namely carbohydrates, proteins and fats.
When the body receives less food for a long period of time than it needs to maintain all its vital functions, we are talking here about malnutrition. According to recent estimates from the Food and Agriculture Organization of the World, about 645 million people in the world suffer from chronic malnutrition.
In the case of nutritional deficiency, we get enough calories, but we lack some basic or micronutrients. In the long run, this also leads to diseases and may even end in death. About two billion people in the world suffer from this hidden hunger, most of them in the countries of the Global South.
But even people in industrialized countries are often deficient in important micronutrients. A study conducted by American researchers showed that between 2007 and 2010, about three-quarters of the United States population did not obtain the recommended daily dose of vitamin D, and more than two-thirds of them did not obtain the recommended amount of vitamin E. In Germany, about a third of the population suffered from a vitamin D deficiency in 2017, according to the German Nutrition Society (DGE). This deficiency leads to pain in the bones, joints and muscles, and may lead to increased susceptibility to falls and bone fractures.
Also, about a third of Germans did not get enough iodine, which is an essential trace element necessary for the formation of thyroid hormones. Iodine deficiency leads to pathological changes or disorders in the thyroid gland. During pregnancy, the growth of the fetus’s brain and nervous system depends on the mother receiving sufficient amounts of iodine.
Improving and genetically modifying plants to increase their resistance or production capacity sometimes results in lower micronutrient content in fruits, vegetables and grains. However, the impact on human health is still a matter of controversy.
Causes of "hidden hunger"
Nutritional deficiencies can arise from a one-sided diet that may appear filling and provide energy, but lacks micronutrients. It contains only "empty" calories such as fast food, ultra-processed foods, as well as white bread and white rice.
Poverty is often a cause of one-sided dieting, for example when people in the Global South can only afford basic foodstuffs, such as flour or rice. A study conducted in Germany indicates that families at risk of poverty often consume foodstuffs that are poor in nutrients and rich in calories.
Even in cases of depression, the risk of nutrient deficiency increases. “People with depression often suffer from a loss of appetite, and when they neglect self-care, their diet may be limited to only one type of food,” says Matthias Perlich. Nutritionist Perlich's research has shown that older people and people who live alone are more likely to suffer from nutritional deficiencies. The risk also increases the more medications a person takes.
Lack of nutrition in hospitals: a third of patients are infected
There are many diseases that impair the body's ability to absorb or benefit from nutrients through the intestines. This applies to people with inflammatory or chronic diseases, such as inflammatory bowel disease, celiac disease, liver disease or cancer.
Estimates of the German Society for Nutritional Medicine (DGEM) indicate that about 30 percent of patients being treated in hospitals in Germany are suffering from malnutrition or are at risk of developing it. However, health insurance company data shows that only about one percent of these patients are seen and treated for nutrient deficiencies.
The patient's nutritional status often deteriorates further during their hospital stay. The consequences can be serious, such as: increased complications, delayed wound healing, longer periods of hospital stay, and increased mortality rates. This results in the health system incurring additional costs of billions of euros annually.
Therefore, politicians and specialized medical associations in Germany are expected to develop a plan until the end of 2027 in order to improve the detection and treatment of malnutrition in hospitals. Just like in the Netherlands, where patients are systematically screened for nutrient deficiencies upon admission to hospital.
How can we prevent nutrient deficiencies?
Matthias Perlich, a physician specializing in nutrition and internal medicine and former vice-president of the German Society for Nutritional Medicine (DGEM), calls for such screening for malnutrition to be carried out in outpatient clinics also in risk groups. “These groups include people with chronic and serious diseases, especially people of advanced age,” Perlich says. In order to prevent malnutrition due to poverty, access to healthy food must be increased, according to him, for example by “providing free meals in schools.”
In general, nutritionist Perlich advises eating as diverse a food as possible and based on plants. He says, "A lot of plant materials have a very positive effect, and when we eat a very diverse diet we get a lot of nutrients that are very beneficial from a nutritional standpoint."
The rule of thumb here: the more diverse our food is, the better. It is also recommended to cook vegetables in ways that preserve their nutritional value, because exposing them to excessive heat and keeping them hot for a long time destroys vitamins. In addition, long storage periods lead to loss of vitamins, so it is better to eat seasonal and local foods.
In conclusion: It is possible that a deficiency in some nutrients may occur, despite great efforts to eat a healthy and balanced diet. This can be verified by performing a blood test. Then nutritional supplements can help compensate for the deficiency.
