Operationalizing the malnutrition-based chronic disease model in adults

The malnutrition-based chronic disease (MBCD) model for use in adults to optimize nutrition care is a framework based on epidemiological classifiers, pathophysiological mechanisms, and clinical evidence, designed to address persistent research, knowledge, and practice gaps. This model incorporates the triple burdens of undernutrition, overnutrition, and micronutrient derangement, disambiguates nutrition medicine terminology, exposes early opportunities for prevention, emphasizes a complications-centric approach, and codifies precise actions. MBCD consists of four stages (1- nutrition risk; 2- nutrition imbalance; 3- nutrition disease; and 4- nutrition complications), impelled by primary (genetics, environment, and behavior), secondary (pathophysiology), and tertiary (social/structural/cultural determinants) drivers. In this paper, we begin the operationalization process of the MBCD model by providing evidence for stage-specific metrics and interventions to enable successful implementation. A search for articles was performed from May 1 to November 1, 2025. The MBCD model aligns with the evolving nutrition medicine ecosystem (including the Global Leadership Initiative on Malnutrition framework), artificial intelligence enabled informatics, and interdisciplinary team approach to improve nutrition research, education, and clinical practice. Adaptations to this model, particularly in pediatrics, are encouraged as new scientific information emerges. This operationalized model requires implementation and empiric validation in diverse populations and clinical settings to accommodate future scientific and experiential realities in the nutrition space.