Definition

NICE defines malnutrition as the following:

• A Body Mass Index (BMI) of less than 18.5; or
• Unintentional weight loss greater than 10% within the last 3-6 months; or
• A BMI of less than 20 and unintentional weight loss greater than 5% within the last 3-6 months

Investigations

Screening for malnutrition is mostly done using MUST (Malnutrition Universal Screen Tool

• It should be done on admission to care/nursing homes and hospital, or if there is a concern e.g. an elderly, thin patient with pressure sores
• It takes into account BMI, recent weight change and the presence of acute disease
• Categorises patients into low, medium and high risk

Management

Management of malnutrition is difficult. NICE recommend the following points:

• Dietician support if the patient is at high-risk
• A 'food-first' approach with clear instructions (e.g. 'add full-fat cream to mashed potato'), rather than just prescribing oral nutritional supplements (ONS) such as Ensure
• If ONS are used they should be taken between meals, rather than instead of meals