Presented by
Daniel Reich, MD, PhD
Malnutrition is a multifaceted condition resulting from insufficient protein/energy balance that adversely affects body composition and physiological reserve. It can stem from disease-specific processes that have high energy demands including immune dysfunction and inflammation. As such, people with MS may be predisposed to malnutrition. Malnutrition a major risk factor for other comorbid conditions such as low skeletal muscle mass (i.e., sarcopenia) and loss of physiological reserve and resilience (frailty). Traditional tools like Body Mass Index (BMI) are frequently used to evaluate nutritional status and cardiometabolic risk, but they offer limited insight into body composition. In MS, BMI often underestimates adiposity and fails to capture clinically relevant changes in skeletal muscle mass and bone density. Importantly, while malnutrition is typically associated with low BMI, it can occur even in individuals with a high BMI. Research indicates that individuals with MS tend to have higher fat mass, lower skeletal muscle mass, and reduced bone mineral density compared to the general population. Together, these factors contribute to frailty, defined as diminished physiological reserve and resilience, and may influence disease progression in MS. This clinical course will focus on malnutrition, body composition, and frailty in MS with specific emphasis on prevalence, risk factors, clinical relevance, screening and assessment methods as well as intervention strategies.