A holistic perspective on malnutrition in older adults: Towards an integrated clinical nutrition research guiding framework

Malnutrition is a multifactorial and complex condition with significant consequences for recovery, functional outcomes, and healthcare systems. Research in malnutrition is often limited by single-component interventions, heterogeneous study designs, and variable outcome measures. This perspective paper introduces a practical guiding framework for clinical nutrition research, emphasizing interdisciplinary, multifactorial approaches, co-designed interventions, and pragmatic, adaptive study designs. Evidence from several trials demonstrates that individualized nutritional support delivered by multidisciplinary teams improves clinical outcomes, yet challenges remain in recruitment, adherence, and balancing intervention intensity with patient burden. The framework provides a structured approach to intervention development, outcome selection, and implementation, while remaining flexible to accommodate innovation, context-specific adaptation, and emerging outcome measures. By integrating lessons from prior trials, globally, and promoting systematic reporting and feasibility assessment, this framework aims to enhance the design, comparability, and translational impact of future research in clinical nutrition in older and other clinically vulnerable populations. Adoption of such a framework can guide research prioritization, optimize intervention delivery, and ultimately improve patient recovery and quality of life.