OBJECTIVES: Disease related malnutrition (DRM) is a frequent but often unrecognised problem, even in the developed world. The objective of this study was to estimate the burden of disease related malnutrition (BoDRM) in Europe. METHODS: An Excel model was developed to estimate direct incremental health care costs and health burden (including increased mortality and reduced quality of life) due to DRM. The monetary value of the health burden was calculated by multiplying the QALY loss with explicit or implicit (2x GDP/capita) cost effectiveness thresholds in each country. Collection of input variables involved a wide spectrum of current data sources: international databases, PubMed, congress abstracts, references from published papers. Ten primary diseases were incorporated into the model: stroke, breast cancer, COPD, dementia, depression, colorectal cancer, musculoskeletal disorders, head and neck cancer, coronary heart disease, chronic pancreatitis. RESULTS: For the 835 million European citizens, the direct financial BoDRM is over 31 billion EUR annually. The estimated annual health burden is approximately 5.7 million life years or 9.1 million QALYs. The total monetary value of the health and financial BoDRM is 306 billion EUR. The health burden in chronic diseases is greater than in acute diseases, and is also greater than the financial burden. In acute diseases, the financial burden is greater than the health burden. CONCLUSIONS: In Europe, DRM is a considerable health and financial burden and represents a significant contribution to the total burden of disease, estimated by WHO to be 255 million DALYs annually. Therefore, there is a need to improve nutritional care in all aspects of patient management. The availability of scientific data on DRM is limited, especially regarding the relative mortality risk and quality of life impact. Policy makers should support programmes to extend the clinical and economic evidence base for nutritional care.