Understanding Protein Calorie Malnutrition

Understanding Protein Calorie Malnutrition

“Understanding Protein Calorie Malnutrition” was written by Registered Dietitian, Aly Bouzek, MS, RDN and reviewed/edited by Katie Dodd, MS, RDN, CSG, LD, FAND

Protein and calorie needs look different for older adults than for younger adults. If needs are not met consistently, then malnutrition can happen. This can be a serious condition among older adults, but help is here!

To learn more about what malnutrition is, how to spot it, and how to prevent it, continue reading below.

What is Protein Calorie Malnutrition?

Malnutrition happens when there is an imbalance of nutrients from your food and drinks that are needed to keep your body healthy and functioning properly (1).

Definition of Protein Calorie Malnutrition

malnutrition in older adultsProtein calorie malnutrition is a type of undernutrition.

Undernutrition happens when you don’t consume enough essential nutrients, or when you use/excrete the nutrients faster than they are replaced (1).

Protein calorie malnutrition happens when you are not consuming enough protein and calories. This can lead to muscle loss, fat loss, and your body not working as it usually would.

So, how much protein and calories do older adults need to consume to avoid malnutrition? Let’s follow along…

Adults need at least 0.8 grams of protein per kilogram of body weight (2). Though research suggests 1.0-1.2 grams of protein per kilogram body weight is more appropriate for aging adults.

As for calories, older adults need between 25 and 35 calories per kilogram of body weight. If you weigh 150 pounds (68 kilograms), you will need about 1700 –2390 calories each day.

These numbers seem high, but don’t worry! You’re in the right place to understand why the numbers are important and how to meet your nutrition goals.

Contributing Factors

It may seem very “cut and dry” when it comes to protein calorie malnutrition, but there’s actually much more to it. Specifically, this type of malnutrition is usually caused by social, physical, and psychological factors.

Some examples include:

  • Illness
  • Medication side effects
  • Restrictive diets
  • Impaired ability to eat
  • Dementia
  • Little income or access to food
  • Normal age-related changes (such as a change in taste buds or ill-fitting dentures) (3)

These factors can combine or escalate quickly. So, it’s important to be prepared and learn the signs and symptoms.

Signs and Symptoms of Protein Calorie Malnutrition

Protein calorie malnutrition can have many negative affects on your body. If you are malnourished, then your body may slow down and not work as it usually does.

Protein Calorie Malnutrition Causes

Watching for signs and symptoms of protein calorie malnutrition is very important. Some signs and symptoms may seem like common aging signs – but watch closely so these warning signs are not overlooked (4)!

Signs and symptoms include:

  • Loss of appetite
  • Feeling tired or weak
  • Feeling depressed
  • Unable to eat
  • Able to eat only small amounts
  • Unplanned weight loss or rapid weight loss
  • Muscle weakness
  • Swelling or fluid accumulation
  • Inadequate diet

Inadequate consumption of protein and calories can lead to deficiencies in vitamins, minerals, and other essential nutrients. This can build quickly and lead to many other signs and symptoms listed above – assisting in malnutrition’s presence.

At Risk for Malnutrition

Older adults are among those who are most at risk for malnutrition. (5) This becomes especially true for those older adults who are hospitalized or institutionalized.

Older adults with certain conditions are also at greater risk for malnutrition. Examples include dysphagia, stroke, depression, eating disorders, etc.

Why are Protein and Calories Important?

As you age, you naturally lose muscle and bone strength. If malnutrition is present, these losses can greatly impact your life and activity level. (6)

Without protein and calories, your body is weaker and everyday tasks can seem daunting or even be impossible. You are at a greater risk for falls, will likely experience lesser mobility, and can have poor muscle strength.

If you lose enough muscle, you might not be able to take care of yourself anymore. It may be difficult to get dressed, walk, prepare meals, etc. This increases the need to move into a higher level of care.

Additionally, your immune system may not be strong enough to keep you healthy or to help you heal from illnesses and wounds.

Even your organs are affected if you don’t get enough protein and calories. Your eyes, kidneys, heart, and brain are a few of your organs that require specific nutrients in order to work properly and maintain your quality of life. 

For example, your eyes need specific vitamins and minerals to stay healthy. If you aren’t consuming enough of these vitamins and minerals, then you are likely to experience vision loss, cataracts, glaucoma, and other eye diseases.

As another example, your brain needs particular nutrients also. Without these nutrients, your brain loses neurons and can lead to weakened coordination, worsened memory, and impaired speech. 

Muscle Protection 101

whey protein older adultsWhen older adults don’t get enough protein and calories, their muscles weaken, and their bone mass decreases.

This can lead to a series of scary events such as falls, hospitalization due to fractures, and can even be fatal. (3)

This is because our muscles need protein! Protein is responsible for building and repairing muscles and bones. Without enough protein, our body cannot complete these tasks.

Resistance and endurance exercise (combined with eating enough protein) also helps with muscle protection by preventing weight loss and muscle loss.

Remember: eating enough protein and calories are important! This will help to avoid unintended weight loss and prevent muscle loss.

Overall Health

Protein and calories are important for your overall health and are necessary to keep you well nourished. Making smart food choices is important, but it is not the only important factor in your health.

It is also beneficial to take care of your oral health. If gum disease occurs, then you risk having dental problems that can negatively affect the way you eat and what foods you eat.

For example, if you don’t brush and take care of your teeth, they could become loose and prevent you from eating foods that require chewing.

To keep your overall health in tip-top shape, make sure to talk to your doctor if you are experiencing poor appetite, unintentional weight loss, problems eating or chewing, ill-fitting dentures, or any other problems with eating.

Know that it’s ok to ask for help! If you find it difficult to drive to get food, prepare food, or are unable to afford food, then find someone who can help you or contact a supplemental program such as Meals on Wheels to get meals delivered to you.

Monitoring Nutrition and Preventing Protein Calorie Malnutrition

Monitoring is an important step in caring for yourself or someone with protein calorie malnutrition. Watch for changes in behavior, appetite, and abilities. Talk to a doctor or Registered Dietitian about your concerns and reach out to others for help.

Monitor Weight and Eating Habits

You can monitor weight by doing a weekly weigh-in and keeping a record of weights. You can also watch for changes in how clothing fits.

Monitor eating habits by eating meals together. It is important to note what foods and drinks are consumed as well as how much is consumed.

You can also prepare meals ahead of time that contain enough protein and calories, prepare a shopping list before going to the store, and try shopping together.

Paying close attention to weight changes and eating habits is crucial to preventing, discovering, and correcting protein calorie malnutrition.

Consistent Consumption Throughout the Day

In addition to monitoring, it’s also important that protein and calories are consumed consistently throughout the day.

Aim for 6 meals and snacks a day. Consuming protein and calories consistently means splitting up the 6 meals and snacks throughout the day and making sure protein is included with each eating time (7).

For example, eat breakfast at 7:00 am, lunch at 12:00 pm, and dinner at 5:00 pm. Snacks can be tucked in between meals such as at 9:00 am, 3:00 pm, and 7:00 pm.

Remember our protein need example from above? Say a smaller woman needed 55 grams of protein a day. So, splitting that up between 6 meals/snacks would look like about 9 grams of protein at each sitting (55 grams ÷ 6 meals = 9.2 grams of protein).

Consistently consuming protein and calories helps your body expect when it will get more nutrients and helps it to adjust functioning accordingly.

high calorie foods to gain weight back

Improving Nutrition

It is important to remember that protein calorie malnutrition cannot be prevented or treated by simply “eating more” (8). Remember, malnutrition is an imbalance of nutrients.

In the case of protein calorie malnutrition, you need to adjust your diet to make sure you are consuming enough protein and enough calories to get all the nutrients your body needs.

Another helpful resource is contacting a Registered Dietitian who specializes in geriatric nutrition.

Nutrient-Dense Food and Drink Sources

Adequate amounts of calories and protein are needed to help prevent and avoid protein calorie malnutrition.

High Calorie High Protein Foods

To choose high protein and high calories foods, look for foods such as:

  • Milk (choose whole milk instead of skim or low-fat)
  • Cheese (choose high-fat cheese instead of nonfat or low-fat)
  • Eggs
  • Meat (choose higher fat instead of lean)
  • Poultry
  • Fatty fish (ex. salmon
  • Nuts
  • Beans
  • Protein or meal replacement bars

Adding spices and herbs to your meals can help boost flavor and eating interest. Try experimenting with different combinations to find your favorites.

High Calorie High Protein Drinks

Choosing high protein and high calorie drinks is a great step towards improving nutrition. These drinks can include shakes, smoothies, and fortified milk. Check out our High Calorie SHAKES e-Cookbook for 25 delicious shake recipes.

High protein and high calories shakes are easy to make and are helpful for older adults avoiding or treating malnutrition. High protein and high calorie smoothies are another great option because you can add fruits and veggies to increase the nutrients!

Fortified milk is when you add powdered milk to your whole milk or other drinks. It’s another way to help increase protein and calories. Try adding chocolate or strawberry syrup for a new flavor (and a calorie boost)!

Additionally, when making or buying drinks, look for those high in calories such as whole milk, juice, or soda with sugar (7). Bonus: whole milk is high in protein too!

Mix and match your high protein and high calorie drinks to keep interest up and boredom down! Experiment with different flavors to find your favorites.

Don’t Forget

Also remember, this boost in calories is likely temporary. Don’t get too caught up worrying about the sugar or fat content in high calorie foods.

The goal is to get more calories to treat protein calorie malnutrition and to prevent potential risks such as falls, hospitalization, or even death.

Protein Supplements

blankProtein supplements come in liquid or powder forms.

Both are effective at making sure you get enough protein. So, feel free to mix and match to best fit your lifestyle and needs.

Premade protein shakes are a great option if you are short on time, resources, or don’t want to try your hand at making homemade protein shakes. They come in all kinds of flavors, so look for high protein and high calorie options when shopping at the store or online.

A few of our favorites include Premier Protein Shake (8 oz gives you 160 calories and 30 grams of protein) and Orgain Protein Shake (11 oz gives you 130 calories and 20 grams of protein).

Protein powders can be mixed with a liquid and used to make your own protein drink at home. You can also add the powder to many different foods including: pancakes, oatmeal, muffins, applesauce, smoothies, and shakes. Check out this post to learn more.

Protein Calorie Malnutrition Conclusion

Protein calorie malnutrition is serious. And, unfortunately, all too common in older adults. Thus, it is so important that older adults consume enough protein and calories for their daily needs. Doing so helps prevent unwanted symptoms such as illness, fatigue, and weight loss.

Protein and calories are necessary to our body’s functioning. We need them to repair and build muscle and bone. Without protein and calories, we are left feeling frail and in danger of getting injured.

Taking care of your overall health and consuming protein and calories consistently throughout the day helps lead to improved nutrition. Additionally, choose nutrient-dense foods and maybe add in a high-calorie high-protein shake or smoothie!

Understanding Protein Calorie Malnutrition


  1. Johns Hopkins Medicine. Malnutrition. https://www.hopkinsmedicine.org/health/conditions-and-diseases/malnutrition. Accessed May 24, 2021.
  2. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Energy, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: National Academy Press, 2005.https://www.nap.edu/read/10490/chapter/1
  3. MAYO Clinic. Senior health: How to prevent and detect malnutrition. https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/senior-health/art-20044699. Published September 17, 2019. Accessed May 25, 2021.
  4. National Council on Aging. The Face of Malnutrition May be More Familiar Than You Think. https://www.ncoa.org/article/the-face-of-malnutrition-may-be-more-familiar-than-you-think. Published September 29, 2016. Accessed May 26, 2021.
  5. Malnutrition. Nursing Times. https://www.nursingtimes.net/archive/malnutrition-20-05-2009/. Published May 20, 2009. Accessed April 28, 2021.
  6. National Council on Aging.10 Ways Malnutrition Can Impact Your Health—and 6 Steps to Prevent It. https://www.ncoa.org/article/10-ways-malnutrition-can-impact-your-health-and-6-steps-to-prevent-it. Published January 5, 2017. Accessed May 25, 2021.
  7. Eat Right. High-Calorie, High-Protein Nutrition Therapy. https://hindscc.instructure.com/courses/244867/files/20650908/download?wrap=1. Accessed May 26, 2021.
  8. National Council on Aging. 5 Malnutrition Facts You Probably Didn’t Know. https://www.ncoa.org/article/5-malnutrition-facts-you-probably-didnt-know. Published August 30, 2016. Accessed May 25, 2021.

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