Malnutrition: Approach to Diagnose, Neurological and Cognitive Sequel, Methods to Eradicate Nutrition Deprivation

Malnutrition remains one of the most widespread and persistent public health challenges of the modern era. It manifests not only as a failure of adequate caloric intake but also through deficits in essential micronutrients and, increasingly, through the excessive consumption of nutrient-poor diets that lead to overweight and obesity. Affecting over two billion individuals globally, malnutrition is responsible for nearly half of all deaths among children under five years of age¹. Its consequences are not limited to physical stunting or weight loss but extend deeply into the biological, cognitive, economic, and intergenerational fabric of society. This review explores malnutrition through three primary lenses: diagnostic frameworks, the neurological and cognitive consequences of early-life malnutrition, and the broad strategies necessary for its sustainable eradication. The discussion begins by examining how modern diagnostics now require a multidimensional approach-encompassing anthropometry, biochemical markers, functional assessments, clinical signs, and environmental determinants-given the often-invisible nature of “hidden hunger.” It then explores in depth the profound and often irreversible effects that early malnutrition has on brain development, ranging from altered myelination and neurotransmission to deficits in cognition, learning, and emotional regulation.
These changes can affect educational outcomes, economic productivity, and quality of life well into adulthood. Finally, the review evaluates eradication strategies rooted in both nutrition-specific and nutrition-sensitive interventions, from community-based therapeutic feeding and micronutrient supplementation to reforms in agriculture, sanitation, education, and social safety nets. Drawing from global evidence and case examples, the article argues that eradicating malnutrition requires a multisectoral, equity-based approach that is adaptive to local needs while informed by global scientific consensus. As the world approaches key milestones in the Sustainable Development Goals (SDG) especially SDG 2 (Zero Hunger) and SDG 3 (Good Health and Well-being), eliminating malnutrition is not only a biomedical necessity but a moral and developmental imperative.

Malnutrition, though historically framed as a deficiency of dietary intake, is now understood to be a complex, multifactorial syndrome involving inadequate, imbalanced, or excessive consumption of nutrients that impair physical, mental, and immunological function. The term encompasses three interlinked forms: undernutrition, including wasting, stunting, and underweight; micronutrient-related malnutrition, which refers to deficiencies or excesses of vitamins and minerals; and overnutrition, primarily represented by overweight and obesity². This triad of nutritional imbalance constitutes one of the leading causes of preventable mortality and morbidity worldwide, affecting individuals across all age groups and geographic regions. While undernutrition continues to be most prevalent in low- and middle-income countries, particularly in Sub-Saharan Africa and South Asia, the rising burden of overweight and obesity has become a significant concern even in resource-limited settings, creating a double burden of malnutrition³. According to the World Health Organization, in 2022 approximately 45 million children under the age of five were wasted, 148 million were stunted, and 37 million were overweight⁴. These figures, though staggeringly high, represent only the visible tip of a much larger iceberg, beneath which lies an unquantified burden of cognitive impairment, maternal and neonatal complications, immune dysfunction, and chronic diseases that manifest silently and span generations⁵.

Figure 1. Comparative prevalence of stunting, wasting, and underweight in children under 5 years across global regions. The chart highlights disproportionately higher malnutrition rates in South Asia and Sub-Saharan Africa relative to global and Latin American averages6.

Diagnostic Approaches

Accurately diagnosing malnutrition requires a shift from simplistic anthropometric measurements toward a more multidimensional, integrative approach that recognises its biological complexity and silent clinical presentation in many forms. While weight-for-height, height-for-age, and weight-for-age indices have historically served as cornerstones of nutritional surveillance, they are insufficient for detecting subclinical or micronutrient-related deficiencies that constitute a significant portion of the global nutritional burden. A truly comprehensive diagnostic framework must therefore encompass anthropometric indicators, biochemical assessments, clinical examination findings, dietary intake analysis, and consideration of environmental and socioeconomic context. These elements, when integrated, provide a more precise picture of both individual and population-level nutritional status, allowing for more targeted and effective interventions.

Anthropometric measurements remain indispensable, particularly in resource-constrained settings where rapid, non-invasive, and inexpensive methods are needed. Standard indicators include stunting (height-for-age Z-score below −2), wasting (weight-for-height Z-score below −2), and underweight (weight-for-age Z-score below −2) as defined by WHO Child Growth Standards7. In acute settings, mid-upper arm circumference (MUAC) is widely used to screen for severe acute malnutrition (SAM), with thresholds such as <11>

Figure 2. WHO Height-for-Age Growth Chart for boys and girls aged 0–5 years. Percentile curves are shown from the 1st to the 99th percentile. Shaded zones below the -2 and -3 Z-score lines indicate thresholds for moderate and severe stunting respectively, as per WHO classification9.

Figure 3. WHO Weight-for-Age Growth Chart for boys and girls aged 0–5 years. The chart displays percentiles from 1st to 99th. Shaded regions beneath the -2 and -3 Z-score lines represent classifications for moderate and severe underweight, respectively, based on WHO standards9.

Figure 4. Mid-Upper Arm Circumference (MUAC) classification bands used for diagnosing acute malnutrition in children aged 6–59 months. Color-coded thresholds differentiate between severe, moderate, and normal nutritional status10.

While anthropometry is useful for identifying growth failure and categorising malnutrition severity, it fails to capture micronutrient deficiencies or functional impairments, which may occur even in children with normal weight or height. 

Additionally, body mass index (BMI) is frequently used in adults to categorise underweight, normal weight, overweight, and obesity. However, BMI alone does not reflect body composition, particularly the loss of muscle mass—sarcopenia—which is increasingly recognised as a critical factor in malnutrition among the elderly or chronically ill.

To overcome these limitations, biochemical markers offer a valuable, though more resource-intensive, means of assessing nutritional status. These tests can detect deficiencies in key micronutrients such as iron (serum ferritin, transferrin saturation), vitamin A (serum retinol), iodine (urinary iodine excretion), zinc (plasma zinc), folate (serum folate), and vitamin B12 (serum cobalamin), among others. For instance, iron deficiency is the most common cause of anaemia globally, and serum ferritin levels below 12 μg/L in children and 15 μg/L in adults are typically used to indicate deficiency, although inflammation can elevate ferritin and confound interpretation11. To address this, ferritin is increasingly measured in conjunction with markers of inflammation such as C-reactive protein (CRP) or alpha-1-acid glycoprotein (AGP)¹2. Serum albumin, though long considered an indicator of nutritional status, is now known to reflect acute-phase responses more than nutritional intake, limiting its diagnostic utility. In contrast, prealbumin (transthyretin) and retinol-binding protein may better reflect short-term changes in nutritional intake but are still influenced by infection and inflammation.

Table 1 Commonly used biochemical and laboratory markers in the clinical evaluation of malnutrition. Alterations in these parameters aid in diagnosing nutritional deficiencies, evaluating metabolic impact, and monitoring response to therapy13.

In patients with chronic kidney disease (CKD), particularly those undergoing dialysis, malnutrition presents as a highly prevalent and complex syndrome known as protein-energy wasting (PEW). This condition arises from a combination of decreased nutrient intake due to uremic anorexia, increased catabolism from systemic inflammation, metabolic acidosis, and nutrient losses during dialysis. Traditional anthropometric tools may be unreliable in this population due to altered fluid status, making specialized tools like the Subjective Global Assessment (SGA), Malnutrition Inflammation Score (MIS), and bioelectrical impedance analysis (BIA) more appropriate for nutritional evaluation. Laboratory indicators such as low serum albumin (<3>

Clinical examination remains a vital component of nutritional assessment, particularly for detecting overt signs of micronutrient deficiencies. These signs include conjunctival pallor in iron-deficiency anaemia; Bitot’s spots and night blindness in vitamin A deficiency; glossitis, angular stomatitis, and peripheral neuropathy in vitamin B-complex deficiency; goitre in iodine deficiency; and dermatitis or growth retardation in zinc deficiency. However, many of these signs lack sensitivity and specificity, and their utility is often limited to moderate or severe cases. Functional indicators, such as grip strength, fatigue resistance, and developmental milestones in children, are increasingly used to complement clinical assessments and offer insight into the physiological consequences of malnutrition.

Dietary assessment is another critical yet often overlooked aspect of malnutrition diagnosis. It involves evaluating food frequency, meal patterns, portion sizes, and nutrient diversity, often using 24-hour dietary recall, food frequency questionnaires (FFQs), or household consumption surveys. One commonly used metric is the Minimum Dietary Diversity Score (MDDS), which assesses whether individuals consume at least five out of ten food groups in a day—an indicator strongly associated with micronutrient adequacy15. For children aged 6–23 months, failure to meet minimum dietary diversity is correlated with stunting and anaemia, highlighting the critical importance of qualitative as well as quantitative aspects of diet. In emergency or low-resource contexts, simplified tools like the Individual Dietary Diversity Score (IDDS) or Household Dietary Diversity Score (HDDS) are used to monitor food insecurity and inform programmatic targeting.

Environmental assessments are also indispensable in understanding malnutrition, as exposure to unsanitary conditions, inadequate water supply, and recurrent infections such as diarrhoea and intestinal parasites significantly impair nutrient absorption and increase metabolic demand. 

Figure 5. The reciprocal cycle between malnutrition and infection. Malnutrition impairs immune defenses, increasing infection risk, while infections reduce nutrient absorption and appetite, worsening malnutrition16.

The concept of environmental enteric dysfunction (EED), a subclinical disorder characterised by chronic intestinal inflammation and malabsorption, has gained prominence in recent years for its suspected role in growth faltering and reduced vaccine efficacy in children living in unhygienic conditions17. Although EED cannot be directly diagnosed without invasive procedures, proxy indicators such as fecal biomarkers (e.g., neopterin, myeloperoxidase), lactulose-mannitol ratio testing, and gut permeability assays are being investigated for field applicability. Incorporating sanitation and hygiene assessments into nutritional diagnostics, especially in areas with high diarrhoeal disease burden, is crucial to capturing the full spectrum of factors affecting nutritional status.

In institutional or hospital settings, comprehensive nutritional screening tools are employed to detect at-risk individuals and monitor progress. Among these, the Subjective Global Assessment (SGA) and the Malnutrition Universal Screening Tool (MUST) are widely used across clinical environments. In pediatric care, tools like the WHO growth charts, Pediatric Yorkhill Malnutrition Score (PYMS), and STRONGkids score have been adopted for nutritional risk screening. For adults, particularly those with chronic diseases such as cancer or renal failure, nutritional risk indices such as the Nutritional Risk Screening 2002 (NRS-2002) or the Global Leadership Initiative on Malnutrition (GLIM) criteria are increasingly used to diagnose and grade malnutrition severity, incorporating phenotypic and etiologic domains18.

In recent years, technology has opened new frontiers in nutritional diagnostics. Mobile-based tools and telehealth platforms are being developed to support frontline health workers in rural or underserved areas. Image-based food recognition systems, wearable devices to monitor caloric expenditure, and artificial intelligence (AI) models for predicting growth trajectories are being piloted in both high- and low-income settings. Furthermore, digital health records and machine learning are being used to stratify malnutrition risk and personalise interventions in ways that were not previously feasible. Despite these advancements, accessibility, affordability, and cultural adaptability remain key challenges to large-scale adoption, especially in remote or fragile settings.

Ultimately, accurate diagnosis is the keystone of effective nutritional intervention. Without a clear and multidimensional understanding of the type, severity, and underlying causes of malnutrition, both clinical care and public health policy risk being misdirected or ineffective. An integrative diagnostic approach, which combines anthropometric, biochemical, clinical, dietary, and environmental data, is thus essential not only for managing individual patients but also for designing population-level nutrition strategies. As global health systems move toward more personalised and data-driven models of care, diagnostics must evolve accordingly to reflect the true complexity of malnutrition and to ensure that no form of nutritional deprivation—whether overt or hidden—goes unrecognised or untreated.

Neurological and Cognitive Sequelae of Malnutrition

Malnutrition in early life has far-reaching consequences beyond visible impairments in growth and weight gain; among its most profound and least reversible effects are those on the developing brain. Nutritional deprivation during critical windows of neurodevelopment can lead to alterations in brain architecture, biochemistry, and function that persist well into adulthood. The brain undergoes its most rapid growth and structural refinement during the first 1,000 days of life—from conception through the first two years—making this period exquisitely sensitive to nutrient availability. The formation of neurons, their migration, synapse formation, pruning, myelination, and neurotransmitter development all depend on a steady supply of macro- and micronutrients, and any disruption during these stages may permanently compromise neural circuitry19.

Maternal malnutrition during the periconceptional and antenatal periods exerts profound and often irreversible effects on fetal brain development. Inadequate intake of macronutrients and essential micronutrients such as folate, iron, and iodine is linked with intrauterine growth restriction (IUGR), preterm birth, and impaired neuronal proliferation and myelination in the fetus20. Folate deficiency, in particular, increases the risk of neural tube defects, while maternal iodine deficiency remains the leading preventable cause of intellectual disability globally. These nutritional insults alter gene expression via epigenetic mechanisms, programming the offspring for lifelong vulnerabilities including poor school performance, behavioural disorders, and increased risk of metabolic diseases in adulthood. The neurodevelopmental trajectory established during gestation is thus inseparably linked to maternal nutritional status.

Protein-energy malnutrition (PEM), the most widely recognised form of early-life undernutrition, interferes with both structural and functional brain development. Studies using neuroimaging and post-mortem histological analysis have demonstrated that children with PEM exhibit reduced brain volume, diminished cortical thickness, smaller hippocampal and cerebellar volumes, and altered dendritic arborisation21. These anatomical changes correlate with lower IQ scores, poor working memory, slower processing speed, and impaired executive function in later childhood and adolescence. For instance, in a landmark study by Grantham-McGregor and colleagues, children who were stunted in early childhood performed significantly worse on cognitive tests at school age, even when controlling for confounding socioeconomic factors22. The persistence of these deficits into adulthood translates into diminished educational attainment, reduced economic productivity, and greater vulnerability to mental health disorders such as depression and anxiety.

Micronutrient deficiencies further exacerbate the neurodevelopmental consequences of malnutrition. Iron, for example, is essential for neuronal energy metabolism, dopamine synthesis, and myelination. Iron-deficiency anaemia during infancy is associated with poor language development, reduced attention span, and long-term behavioural problems23. Similarly, iodine deficiency, particularly in prenatal and early postnatal periods, is a leading cause of preventable intellectual disability worldwide. Severe iodine deficiency leads to cretinism, characterised by profound mental retardation, hearing deficits, and motor spasticity, while even mild to moderate iodine deficiency can reduce average IQ by 10 to 15 points in affected populations24. Zinc, another critical micronutrient, supports neurogenesis, synaptic plasticity, and neurotransmitter regulation. Its deficiency is linked to delayed cognitive development, reduced attention, and altered emotional regulation. Vitamin B12 and folate, which are involved in one-carbon metabolism and DNA synthesis, are crucial for brain growth and myelination; deficiencies in these vitamins have been implicated in cognitive impairments and even neuropsychiatric symptoms in children25.

Malnutrition-induced neurological damage is not merely structural but also biochemical and functional. The composition and function of neurotransmitters—including dopamine, serotonin, gamma-aminobutyric acid (GABA), and acetylcholine—are modulated by nutrient availability. Amino acids such as tryptophan and tyrosine, which serve as precursors to serotonin and dopamine respectively, are dependent on adequate dietary protein intake. Deficiencies can disrupt neurotransmitter synthesis, contributing to mood disorders, behavioural dysregulation, and cognitive delays26. Animal studies have confirmed that malnourished pups exhibit lower levels of neurotransmitter activity, reduced brain-derived neurotrophic factor (BDNF), and poor synaptic efficacy. While extrapolation to humans should be cautious, similar biochemical patterns have been observed in malnourished children, particularly those suffering from severe acute malnutrition (SAM), who often present with apathy, irritability, and diminished responsiveness.

One of the most concerning aspects of early-life malnutrition is that its cognitive consequences often persist despite later nutritional rehabilitation. Although catch-up growth in height and weight is possible if adequate nutrition is provided during early to middle childhood, full recovery of brain function is far less consistent. This is due to the time-sensitive and sequential nature of brain development; missed windows of synaptogenesis or myelination may not be revisited, and certain neural pathways may remain underdeveloped even after anthropometric recovery. Longitudinal cohort studies, such as those from the Barbados Nutrition Study and the Guatemalan INCAP project, have shown that early undernutrition predicts poor cognitive and socio-emotional outcomes decades later, even after adjusting for socioeconomic variables27. These findings highlight the urgent need for preventive rather than solely corrective interventions.

Furthermore, the impact of malnutrition on cognition is modulated by environmental and psychosocial contexts. Children exposed to nutritional deprivation are often also subject to multiple other adversities, such as maternal depression, inadequate stimulation at home, poor-quality childcare, and exposure to violence or neglect. These risk factors interact in complex ways with malnutrition to produce synergistic harms. The concept of “cumulative risk” suggests that multiple concurrent adversities amplify developmental deficits beyond the sum of their individual effects28. For example, a child suffering from both iron deficiency and limited verbal interaction may experience disproportionately worse language outcomes than would be expected from either risk factor alone. Conversely, protective factors such as breastfeeding, responsive parenting, and early childhood education can mitigate some of the cognitive damage caused by early malnutrition, underscoring the importance of integrated interventions that address both nutritional and environmental inputs.

Emerging evidence from neuroimaging studies reinforces the idea that malnutrition not only delays but also reshapes neurodevelopment. Functional magnetic resonance imaging (fMRI) studies have shown altered connectivity patterns, lower activation of prefrontal and parietal cortices, and diminished white matter integrity in children who were undernourished in early life29. Electroencephalographic (EEG) studies have demonstrated altered brain wave patterns and delayed event-related potentials (ERPs), which are consistent with attentional and processing deficits. These physiological markers provide objective evidence of malnutrition-induced changes in brain function and offer promising tools for early detection and monitoring of cognitive recovery. However, such technologies remain largely inaccessible in many low-resource settings, limiting their current utility to research rather than clinical practice.

In adolescents and adults who experienced childhood malnutrition, the consequences extend into domains of self-regulation, academic success, employability, and mental health. There is growing evidence that early undernutrition increases vulnerability to depression, anxiety, and cognitive decline in later life, possibly through epigenetic mechanisms and persistent inflammation. Chronic undernutrition has been linked to dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, which in turn may affect stress reactivity, mood regulation, and susceptibility to chronic disease30. Additionally, individuals who were malnourished in early life often exhibit reduced economic productivity, lower lifetime earnings, and diminished contributions to societal growth. The World Bank estimates that malnutrition can cost countries up to 11% of their gross domestic product annually through lost productivity and increased healthcare expenditures31.

In summary, the neurological and cognitive sequelae of malnutrition are among its most devastating and least visible consequences. These effects emerge early, persist long after physical recovery, and impact not only the individual but society at large through loss of human capital and increased dependency. Effective responses must therefore prioritise early detection, timely intervention, and integration of nutritional strategies with psychosocial stimulation, maternal health, and developmental surveillance. Eradicating malnutrition is not only about saving lives but about safeguarding the minds and futures of generations to come.

Strategies for Eradication

The eradication of malnutrition is not simply a function of increasing food availability, but rather a multifaceted endeavor that requires coordinated action across health, agriculture, education, sanitation, gender equality, and governance systems. Given the complex and context-specific nature of malnutrition, successful eradication strategies must combine nutrition-specific interventions—targeted actions addressing immediate determinants of malnutrition—with nutrition-sensitive interventions that tackle its underlying and systemic causes. The overarching goal is not just to reduce the prevalence of stunting, wasting, or micronutrient deficiencies but to ensure optimal growth, cognitive development, and human capital formation across the lifespan. Global evidence increasingly suggests that no single intervention is sufficient on its own; only synergistic, multisectoral strategies tailored to the local epidemiological and socio-cultural context can produce sustainable reductions in malnutrition32.

Nutrition-specific interventions are those that directly influence the intake, absorption, or utilisation of nutrients and include approaches such as promotion of exclusive breastfeeding for the first six months, appropriate complementary feeding, micronutrient supplementation, and the therapeutic management of acute malnutrition. Among these, exclusive breastfeeding remains the single most impactful intervention for infant nutrition, reducing the risk of infections, enhancing cognitive development, and improving survival33. The promotion of timely and appropriate complementary feeding practices after six months is equally critical, particularly in environments where food diversity is limited. 

Figure 6. The First 1000 Days: A critical window for nutrition intervention spanning from conception to two years of age. Interventions during this period—including maternal supplementation, exclusive breastfeeding, complementary feeding, and micronutrient provision—are vital for optimal growth and neurodevelopment34.

Nutritional counselling for caregivers, community-based peer education programs, and mass communication strategies have all shown success in improving feeding practices when culturally adapted and contextually relevant. Micronutrient supplementation—including iron, vitamin A, folic acid, iodine, and zinc—has been shown to reduce morbidity and mortality, especially among young children and pregnant women. For instance, large-scale vitamin A supplementation programs have significantly lowered child mortality rates in several countries, while salt iodisation remains one of the most cost-effective interventions for preventing iodine deficiency-related disorders35.

In cases of moderate to severe acute malnutrition, therapeutic feeding programs using ready-to-use therapeutic foods (RUTF) or fortified blended foods (FBFs) are essential. Community-based management of acute malnutrition (CMAM) has revolutionised the treatment paradigm by allowing children to be treated in their communities rather than requiring inpatient care. Studies have demonstrated that CMAM programs achieve high recovery rates, low mortality, and good cost-effectiveness when implemented with adequate supply chains, community engagement, and health worker training36. However, challenges such as stockouts, poor follow-up, and stigma associated with malnutrition can limit program efficacy, particularly in fragile or conflict-affected settings. Moreover, long-term sustainability of therapeutic feeding depends on robust integration with preventive care, health systems strengthening, and food security policies.

Beyond these direct interventions, nutrition-sensitive approaches address the structural determinants of malnutrition. These include agricultural interventions to enhance the availability, diversity, and affordability of nutritious foods; social protection programs such as cash transfers or food vouchers that improve household purchasing power and reduce the impact of shocks; and educational initiatives that promote maternal literacy, women’s empowerment, and child-rearing knowledge. Agricultural diversification, home gardening, and biofortification of staple crops with nutrients such as vitamin A (e.g., golden rice), iron, or zinc offer promising avenues for improving micronutrient intake at the population level. For instance, the HarvestPlus program has successfully introduced biofortified crops in multiple countries with measurable impacts on dietary adequacy and child health37. Food fortification of commonly consumed staples—such as salt, flour, and oil—with essential micronutrients also plays a crucial role in population-wide nutritional improvement, particularly in urban settings where processed foods dominate the diet.

Social protection programs are increasingly recognised as both poverty alleviation and nutritional interventions. Unconditional and conditional cash transfer schemes, public employment programs, and school feeding initiatives not only improve food security but also promote health-seeking behaviours and educational access. For example, Latin American countries such as Brazil and Mexico have demonstrated how large-scale conditional cash transfer programs (e.g., Bolsa Família, Oportunidades) can reduce childhood stunting and anaemia by improving household food intake and increasing utilisation of health services38. In many contexts, linking cash or food assistance with behaviour change communication and health services can amplify impact. However, program design must carefully consider targeting mechanisms, frequency and size of transfers, and social acceptability to prevent unintended consequences such as dependency or misuse.

Water, sanitation, and hygiene (WASH) interventions form another indispensable component of nutrition-sensitive strategies. Repeated enteric infections and environmental enteric dysfunction can significantly impair nutrient absorption and increase energy expenditure, thereby contributing to stunting and wasting even in children who receive adequate calories. Provision of safe drinking water, access to improved latrines, handwashing with soap, and behaviour change campaigns have all been shown to reduce diarrhoeal disease and improve child growth indicators. Although large-scale WASH trials such as the WASH Benefits and SHINE studies have yielded mixed results in terms of linear growth improvements, there is consistent evidence that integrated WASH and nutrition interventions outperform stand-alone approaches39. Effective implementation requires not just infrastructure development but also sustained community engagement, hygiene education, and maintenance systems.

Education and empowerment, particularly of women and adolescent girls, represent powerful yet often underutilised levers for nutritional improvement. Maternal education has been consistently associated with better child feeding practices, higher immunisation rates, and improved health service utilisation. Programs that promote girls’ education, delay early marriage, and support reproductive health services contribute indirectly but meaningfully to nutritional gains by enabling informed decision-making and autonomy in household resource allocation. Nutrition education in schools and through mass media campaigns can also shape dietary behaviour across generations. Furthermore, integrating nutrition into school curricula, teacher training, and national education policy can help institutionalise lifelong healthy behaviours.

An emerging but critical domain of intervention is governance and policy coherence. Strong political commitment, transparent accountability mechanisms, and intersectoral coordination are essential to translate nutritional priorities into action. Many countries have developed multisectoral nutrition action plans, national food and nutrition policies, and high-level coordinating bodies. However, these frameworks often suffer from inadequate funding, fragmented implementation, and poor monitoring. Global initiatives such as the Scaling Up Nutrition (SUN) Movement, the Global Nutrition Report, and the United Nations Decade of Action on Nutrition have emphasised the importance of aligning national priorities with global targets, including the WHO Global Nutrition Targets 2025 and the SDGs40. 

Figure 7. The interconnection of malnutrition with the United Nations Sustainable Development Goals, particularly SDG 2 (Zero Hunger), SDG 3 (Good Health and Well-being), and SDG 4 (Quality Education). Progress in nutrition catalyzes advancement across health, development, and human capital outcomes41.

Investment in robust monitoring and evaluation systems, data disaggregation, and real-time feedback loops is necessary to ensure course correction and accountability.

Technological innovation holds promise for scaling up nutritional interventions and improving targeting. Digital platforms, mobile health applications, remote growth monitoring tools, and AI-based predictive analytics are increasingly being used to identify at-risk populations, support frontline health workers, and track program performance. For example, real-time digital dashboards have enabled governments to map malnutrition hotspots and allocate resources more efficiently. Similarly, mobile applications are being used to deliver nutrition counselling, track dietary intake, and improve caregiver knowledge. While promising, these tools must be accompanied by investments in digital literacy, infrastructure, and data governance to ensure equity and impact.

Importantly, community ownership and participation are central to the sustainability of any nutrition program. Community-based delivery mechanisms, local food production, and empowerment of community health workers create resilient systems that can adapt to local needs and shocks. Participatory approaches, such as community-led total sanitation (CLTS) or participatory learning and action (PLA) cycles, have shown success in shifting behaviours and improving nutritional outcomes when implemented with cultural sensitivity and long-term commitment.

In conclusion, eradicating malnutrition requires a comprehensive, multisectoral strategy that goes far beyond food distribution or clinical supplementation. It demands structural reforms, political will, and societal transformation. Interventions must be tailored to local contexts, informed by scientific evidence, and driven by equity and inclusion. The dividends of such investment are manifold—enhanced cognitive development, improved health, increased productivity, and more resilient societies. In the pursuit of sustainable development, few goals are as foundational and transformative as the elimination of malnutrition.

Conclusion

Malnutrition, in its many forms, remains one of the most significant global health and development challenges of the 21st century. Despite considerable advances in public health, agriculture, and economic growth, the burden of undernutrition, micronutrient deficiencies, and diet-related noncommunicable diseases continues to compromise the potential of individuals, families, and nations alike. The consequences of malnutrition are neither short-lived nor confined to physical dimensions; they extend deeply into cognitive functioning, social capital, educational outcomes, and intergenerational development. As shown throughout this review, the true cost of malnutrition lies in the erosion of human potential, the perpetuation of inequality, and the long-term economic stagnation that follows when generations are cognitively impaired, chronically ill, or socioeconomically marginalised due to early-life nutritional deprivation.

The challenge of malnutrition is deeply complex, driven by biological, environmental, social, economic, and political determinants that interact in dynamic and context-specific ways. No single intervention—no matter how evidence-based—can eliminate malnutrition in isolation. Diagnosis must move beyond weight and height metrics to include biochemical, dietary, functional, and environmental dimensions. The neurological and cognitive consequences of malnutrition require urgent recognition in both clinical practice and policy, with special emphasis on early-life nutrition, maternal health, and psychosocial stimulation. Interventions must be simultaneously nutrition-specific and nutrition-sensitive, bridging sectors such as agriculture, education, sanitation, social protection, and digital governance. Moreover, the growing availability of data and technology offers an unprecedented opportunity to personalise interventions, monitor impact, and mobilise political will with real-time insights.

Achieving global nutrition targets—whether through the Sustainable Development Goals or national action plans—requires coordinated governance, sustainable financing, local ownership, and adaptive program design. It also requires the inclusion of vulnerable and marginalised populations, whose nutritional needs are often the most acute yet least visible. In this way, nutrition becomes not merely a health agenda but a human rights imperative, a foundation for equity, and a precondition for peace, productivity, and planetary well-being. The eradication of malnutrition is within reach, but only if it is pursued with the urgency, comprehensiveness, and justice it demands.