The Managing Adult Malnutrition in the Community panel has updated its guidance for community healthcare professionals. The updated guide reflects the latest evidence and best practice and is encouraging professionals to consider a four-step approach to the management of disease-related malnutrition:
- Step 1: Identification of malnutrition: nutrition screening
- Step 2: Assessment: identifying the underlying cause of malnutrition
- Step 3: Management: identifying treatment goals and optimising nutritional intake
- Step 4: Monitoring the intervention
Developed by a multi-professional panel with an expertise and interest in malnutrition, the evidence-based document has been updated to incorporate the most up-to-date national and international guidance as well as high quality, peer reviewed research. It emphasises the role of the multi-disciplinary team in identifying and managing malnutrition, working alongside dietitians, and provides information for non-nutrition experts on actions to optimise dietary intake along with appropriate prescribing of oral nutritional supplements (ONS) when required.
Three patient leaflets accompany the guidance document. The document and leaflets have been endorsed by ten key professional and patient organisations including the British Dietetic Association (BDA), The British Association for Parenteral and Enteral Nutrition (BAPEN), the Royal College of Nursing (RCN), the Royal College of General Practitioners (RCGP), the Royal Pharmaceutical Society (RPS) and the Patients Association1.
The clinical consequences of malnutrition can be profound. Studies have repeatedly demonstrated that undetected and untreated malnutrition reduces muscle strength, contributes to frailty, increases falls risk, slows recovery from illness and surgery, impairs psycho-social function, immune response and wound healing, all of which are associated with poorer clinical outcomes2-6. The cost of malnutrition in the UK exceeds £23.5 billion per annum6. At an individual level, a malnourished patient costs three times more to manage than a non-malnourished individual (£7,408 versus £2,155)7. Action to detect, treat and prevent malnutrition are therefore justified on both a clinical and cost basis.
Groups most at risk of malnutrition include those with chronic disease, progressive neurological disease, frailty, neuro-disability, swallowing difficulties, acute illness and those with end of life/palliative care needs. Patients undergoing prehabilitation and rehabilitation, prior to and after surgery, are also at risk and it is important that their nutritional status is optimised to prepare them for surgery and assist in their recovery. The needs of obese individuals in whom a high body mass index can mask malnutrition and sarcopenia (a loss of muscle mass and strength) should also be given special consideration.
“This updated guidance aims to raise awareness amongst community healthcare professionals of how the underlying causes of malnutrition may be alleviated to break the repeated cycles of malnutrition, particularly amongst those with long-term conditions.” says Dr Anne Holdoway, Consultant Dietitian and Chair of the Managing Adult Malnutrition in the Community panel. “Identifying the causes and symptoms which are interfering with a patient’s ability to eat and drink and addressing those that can be reversed or modified, needs to be an integral part of the patient’s treatment plan. Such plans also need to consider the person’s ability to act on the advice given and mitigate for any barriers either clinical, practical or social, that may affect adherence to dietary advice and, if prescribed, the choice and type of oral nutritional supplements. I hope this guidance will assist professionals in taking action early, know when to refer on to a Dietitian, and ultimately take us one step closer to optimising nutritional care for all our patients.”
“Unintentional weight loss is a red flag and may need a 2 week wait referral” says Dr Anita Nathan, GP member of the Managing Adult Malnutrition in the Community panel. “Whilst malnutrition will most frequently occur in those who are underweight, the malnutrition of our overweight and obese patients can be overlooked. It is hoped that by encouraging community healthcare professionals to implement appropriate screening, including observations such as unintentional weight loss and poor appetite or impaired swallow, with further assessment of such issues, we can aim to ensure the at-risk patients don’t slip through the net.”
“This resource gives useful guidance for the whole multi-disciplinary team on the identification and management of malnutrition” says Dr Graham Stretch, PCPA President and PCN Clinical Director. “It is evident that the nutritional status of patients has a direct effect on their outcomes. With a spotlight on the nation’s health post-COVID, nutrition should become front and centre of care. The formation of PCNs has allowed groups of practices healthcare professionals with specialist skills as members of their team and I would encourage PCN Directors to read this guidance and consider the benefits of engaging a Dietitian as part of that multi-disciplinary team to ensure that nutritional care becomes an integral part of patient care pathways.”
‘Managing Adult Malnutrition in the Community’
The first edition of the ‘Managing Adult Malnutrition in the Community’ guidance was launched in 2012 and it complements the ‘Managing Malnutrition in COPD’ guidelines and ‘A Community Healthcare Professional Guide to the Nutritional Management of Patients During and After COVID-19 Illness’.
The document is based on clinical experience and evidence alongside accepted best practice. A full free copy of the guide can be downloaded by clicking on the image below.
Patient and Carer leaflets
The guidance is accompanied by three complementary colour-coded leaflets for use by patients and their carers which have been updated to ensure they support the cultural diversity of patients. The three leaflets are:
- Nutrition Drinks (known as Oral Nutritional Supplements) – red leaflet for those at high risk of malnutrition. This leaflet outlines to patients why they have been prescribed oral nutritional supplements and offers them general advice on getting the most from their supplements, for example advice on cooking with supplements and storage
- Your Guide to Making the Most of Your Food – yellow leaflet for those at medium risk of malnutrition, which provides some simple ideas for patients on how they can get the most nutrition from the food they are eating
- Eating Well – green leaflet for those at low risk of malnutrition, gives patients advice on how to eat well and keep as healthy as possible
All three leaflets can be downloaded for free via www.malnutritionpathway.co.uk/leaflets-patients-and-carers
NB: Production of the ‘Managing Adult Malnutrition in the Community’ materials was made possible by an unrestricted educational grant from Nutricia.