Managing Adult Malnutrition

The development of the ‘Managing Adult Malnutrition in the Community’ document came about as a consequence of a 2011 qualitative review carried out by Anne Holdoway, Consultant Dietitian, of guidance on managing malnutrition available across the UK. This research identified a variety of guides of varying lengths, offering inconsistent advice, lack of goal setting, absence of outcome measures and scant use of evidence. A concurrent survey undertaken with GPs across the UK, identified that Healthcare professionals were keen to have easily accessible, evidence-based advice on the subject of malnutrition. As a result of these two pieces of work, Anne convened a panel of experts representing healthcare professionals in the community, to address the resource gap and develop succinct guidance based on published, peer reviewed evidence and clinical experience where evidence was limited.

The resulting guidance, including pathways for identifying and treating malnutrition and a guide to assist in the appropriate use of oral nutritional supplements (ONS), was launched in 2012 and updated in 2017 and 2021.

Complementary guidance was produced in 2016 specifically aimed at malnourished patients with COPD, involving experts in COPD and malnutrition across the multidisciplinary team. An updated version of this guidance was launched in January 2020.

Both documents are endorsed by a number of key professional and patient organisations and each includes a NICE endorsement statement.

Patient materials have also been developed alongside the ‘Managing Adult Malnutrition in the Community’ and ‘Managing Malnutrition in COPD’ documents and are free to download.

In recent years we have extended the resources to include a number of fully referenced complimentary fact sheets.

A collaborative approach

We aim to raise awareness of the issue of disease-related malnutrition in the community and to provide professionals and patients with materials to assist them to identify, manage and reverse malnutrition. We are keen to work with other like-minded professionals and welcome input into our materials and the sharing of initiatives through our regular PATHWAY NEWSLETTER

We work closely with other national organisations such as the British Association for Parenteral and Enteral Nutrition (BAPEN) and the Malnutrition Taskforce as well as local NHS trusts to tackle the issue of disease-related malnutrition in the UK.

We are grateful to all the professional and patient organisations who have endorsed the guidelines and who continue to assist us in disseminating information on the identification and management of malnutrition to their members.

In addition we would like to thank Nutricia Advanced Medical Nutrition for their funding of a number of our initiatives via an unrestricted educational grant, without the assistance of outside funding we would be unable to produce many of these much need materials.

Our panel

A number of experts in the field of malnutrition have been involved in assisting us to develop materials. Some of our key panel members are listed below:

Chair: Dr. Anne Holdoway Anne has over 30 years’ experience in NHS dietetics, private practice, industry and research and was awarded the prestigious fellowship of the British Dietetic Association in 2016.

She was responsible for initiating the development of the multi-professional ‘Managing Adult Malnutrition in the Community‘ consensus panel and has been chair of the panel since its inception in 2011. She is also on the ‘Managing Malnutrition in COPD’ panel and is Education Officer for the British Association of Parenteral and Enteral Nutrition (BAPEN).

Anne is an international speaker on disease-related malnutrition and has recently completed doctoral research on the role of nutrition and diet in palliative care. For the past decade, Anne has dedicated much of her personal time to work with national organisations including NICE, BAPEN, BDA, BSG and the RCGP, to raise the profile of the role of nutrition in healthcare.

GP representative: Dr Anita Nathan Dr Nathan has been a practising General Practitioner (GP) in London for over 15 years. She is a member of the GPs Interested in Nutrition Group (GPING) (an RCGP Specialist Group). She is GP representative on the ‘Managing Adult Malnutrition in the Community’ and ‘Managing Malnutrition in COPD’ consensus panels. Dr Nathan is also a GP member on the RCGP Patient and Carer Partnership Group.

Nurse representative: Liz Anderson Liz Anderson, Lead Nurse for Nutrition, Bucks Healthcare NHS Trust has been involved in the development of both the Managing Adult Malnutrition in the Community and Managing Malnutrition in COPD documents. Liz is an experienced nutrition nurse specialist with over 30 years of nursing under her belt. Liz has contributed to a number of national nutrition initiatives and guidelines and is a seasoned speaker at conferences as well as being published a number of times in various nursing journals. A past Chair of the National Nurses Nutrition Group, Liz is also Patient Experience Officer for the British Association of Parenteral and Enteral Nutrition (BAPEN).

Managing Malnutrition in COPD expert: Dr Peter Collins Dr Collins is a Senior Lecturer in Nutrition & Dietetics in the School of Allied Health Sciences at Griffith University, Australia. He is a UK Registered Dietitian (RD) and an Accredited Practising Dietitian (APD) and a member of the Patient-Centered Health Services research group at The Menzies Health Institute Queensland. Peter completed his PhD in the Faculty of Medicine at the University of Southampton investigating the effectiveness of nutritional support in treating malnutrition in outpatients with COPD. Dr Collins is an Early Career Faculty member of the European Society for Clinical Nutrition and Metabolism (ESPEN) and is an Associate Editor for Clinical Nutrition ESPEN and is on the editorial board of the Journal of Human Nutrition and Dietetics.

Managing Malnutrition in COPD expert: Professor Tom Wilkinson is Professor of Respiratory Medicine at the University of Southampton and a Consultant at UHS NHS FT specialising in airways disease. Tom is a member of the British Thoracic Society Specialist Advisory Group on COPD and has contributed to and chaired national guidelines on COPD care. He leads a multi-disciplinary research team covering all aspects of disease related research including nutrition.

Practice Pharmacist Representative: Sam Cudby Sam is an independent prescriber who specialises in providing advice and support to residents in care homes (nursing, residential and learning disability) as well as older people in the community. She has developed a particular interest in managing malnutrition, frailty, osteoporosis and managing medicines in patients with dysphagia/PEGs fitted.

Dietitian Representative: Louise Nash Louise is a specialist frailty and home tube feeding dietitian based at Airedale NHS Foundation Trust in Keighley, West Yorkshire. She works with frail older people who are malnourished and deconditioned, supporting them to improve their nutrition in order to prevent associated problems such as falls and infections which can result in lengthy, complex hospital admissions. Many of these patients have underlying disease, including respiratory, neurological and gastrointestinal conditions and cancers. Other specialist roles have included diabetes education, renal and learning disabilities. She works with local community teams, supporting them to provide good nutritional care and guidance through training and pathway development. She has written articles in national publications of a range of healthcare professions and been a regular speaker at national conferences and training days.

Communications: Hilary Franklin Hilary manages the Managing Adult Malnutrition in the Community communications activities and events and is responsible for liaising with the professional and patient organisations who endorse the materials. She has over 25 years of experience in developing and implementing communications campaigns and healthcare education projects and has been involved with the ‘Managing Adult Malnutrition in the Community’ and ‘Managing Malnutrition in COPD’ campaigns since their inception. Hilary is a freelance Healthcare Communications Consultant.

Website: Kim Spickett Kim looks after the development of malnutritionpathway.co.uk and is involved in the design of a number of the educational materials on the site. For the past twenty years Kim has held a partnership in her own creative agency, designing printed and digital material for both healthcare and consumer marketing environments.

Resources

A selection of publications for use by healthcare professionals, patients and carers are available in the resources section of the website.

RESOURCES AREA