Some 50,000 deaths can be attributed to malnutrition in Germany each year, according to the German Society for Nutritional Medicine (DGEM).
The problem is that malnutrition often doesn't become apparent until the consequences are already severe.
"In most cases, you don't notice anything at first," said Matthias Pirlich, a nutritional expert and internal medicine specialist, who once served as DGEM vice president. "You could have a severe vitamin D deficiency for months before any symptoms appear at all. The same applies for vitamin B12. By the time symptoms appear, such as nerve damage, it's already too late."
A long-term B12 deficiency can damage the spinal cord, leading to numbness in the limbs, muscle weakness or even paralysis. Less common deficiency-related brain damage can cause memory loss and mental health issues.
Undernutrition vs. malnutrition
All B vitamins play an important role in metabolism, blood formation and healthy nerve function.
Vitamins, along with various minerals such as calcium, magnesium, iron, iodine and zinc, are classed as micronutrients. The body needs to source them from food, as it cannot produce them itself. Our bodies also need macronutrients like carbohydrates, protein and fats that provide us with energy.
If the body consumes less food than it needs to maintain all bodily functions over a prolonged period of time, then this is known as undernutrition. A recent World Food Organization (FAO) report estimates that approximately 645 million people worldwide suffer from chronic undernutrition.
Malnutrition, on the other hand, occurs when we consume enough calories but lack certain macronutrients or micronutrients in our food. This, too, can make one sick over time and even prove fatal. About 2 billion people worldwide suffer from this so-called hidden hunger, most of them in the Global South. That said, even some people in industrialized nations lack important micronutrients in their nutrition.
One study, for instance, found that just under three-quarters of the US population did not meet the recommended daily intake of vitamin D between 2007 and 2010, with more than two-thirds falling short of the recommended amount of vitamin E. And in Germany, about one-third of the population suffered from vitamin D deficiency in 2017, according to the German Nutrition Society. Such deficiency can cause bone, joint and muscle pain. It may also lead to an increased risk of falls and bone fractures.
About one-third of Germans also had an insufficient intake of iodine, a trace element that is indispensable for the production of thyroid hormones. Iodine deficiency can therefore disrupt normal thyroid function. Not only that — during pregnancy, a baby's brain and nervous system can only properly develop with an adequate supply of iodine.
The cultivation of agricultural produce with partially long shelf life or high yields has in some cases caused a decrease in the micronutrient content of fruits, vegetables and grains. Whether this drop in micronutrients is impacting human health, however, is a matter of debate.
Empty calories
Malnutrition can result from an unbalanced diet that, while filling and providing energy, lacks essential micronutrients. Examples of such empty calories include fast food and highly processed foods, as well as white bread and white rice.
Poverty is often the reason for such an unbalanced diet, for example when people in the Global South can only afford to buy staples such as flour or rice.
Another study found that in Germany, households at risk of poverty are more likely to consume foods that are low in nutrients and high in calories.
Depression is also associated with an increased risk of nutrient deficiency. "People often lose their appetite, and when they neglect their self-care, they may end up eating a very unbalanced diet," Pirlich told DW. His research shows that older adults and people who live alone often develop malnutrition, too. The risk also increases the more medications a person takes.
Many diseases result in the body being less efficient at absorbing or utilizing nutrients through the intestines. This applies to people with inflammatory or chronic disease, such as Crohn's disease, celiac disease, liver disease and cancer.
Malnutrition and hospital care
The DGEM estimates that some 30% of all patients receiving inpatient care in Germany are affected by or at risk of malnutrition. Yet health insurance data shows that only about 1% of patients are screened and treated for nutrient deficiencies.
Often, patients' malnutrition worsens during their hospital stay. The consequences can be serious, potentially causing additional complications, delayed recuperation, longer hospital stays and even increased mortality rates. This results in higher healthcare expenditure, amounting to billions each year.
German policymakers and medical associations are therefore developing a plan to better screen for and treat malnutrition in hospitals. The road map will be ready by 2027 and copy the Dutch approach in the sense that all patients are checked for nutritional deficiencies upon hospital admission.
How can we avoid nutrient deficiency?
Pirlich wants to see such screenings for at-risk groups in outpatient clinics, too: "This includes all those with chronic and serious illnesses and, above all, older adults."
To prevent poverty-related malnutrition, Pirlich suggests increased access to healthy food, offering free school meals as an example.
The nutritional expert recommends eating a diet that is varied and largely plant-based. "Secondary plant compounds have a very positive effect, and if you eat a highly diverse diet, you consume many different foods that are [nutritionally] beneficial," said Pirlich.
There's a simple rule of thumb: The more colorful your food, the better.
Also, cook vegetables as gently as possible, because overheating and keeping them warm for too long destroys their vitamins. Long storage periods also lead to vitamin loss, so it makes sense to go for seasonal and regional foods in particular.
But even when ensuring a healthy and balanced diet, some people still develop a nutrient deficiency. A blood test can provide clarity, and dietary supplements may help make up for the deficiency.
This article was originally written in German.
