Managing Adult Malnutrition

The Malnutrition Pathway C.I.C.

The Malnutrition Pathway is a registered Community Interest Company (C.I.C.), operating on a not-for-profit basis with no shareholders. All funding is reinvested into initiatives that raise awareness of malnutrition arising from disease and chronic conditions and empower healthcare professionals, patients, and families to take timely action to diagnose, treat, and prevent malnutrition and ultimately improve health outcomes and quality of life.

Our activities include:

• Developing free educational resources for both professionals and patients
• Attending and contributing to educational events
• Writing for professional journals to raise awareness and share best practice

Guidance Documents

The Managing Adult Malnutrition in the Community document was developed following a 2011 qualitative review by Consultant Dietitian Anne Holdoway. The review identified inconsistent guidance across the UK, lacking in goal setting, outcome measures, and clinical evidence. A concurrent survey of GPs revealed a clear demand for practical, evidence-based resources on malnutrition.

In response, Anne convened a panel of national experts from across the community-based multidisciplinary team to develop accessible guidance based on clinical evidence and frontline experience. The original document launched in 2012 and was updated in 2017 and 2021. A new update is currently underway in 2025 to ensure continued relevance and alignment with the latest evidence and practice. The core guidance includes:

• A step-by-step pathway for identifying and managing malnutrition
• Advice on the appropriate use of oral nutritional supplements (ONS)

Complementary guidance was produced in 2016 specifically aimed at supporting the nutritional care of patients with chronic obstructive pulmonary disease (COPD), involving COPD experts. Updated versions of this guidance were produced in January 2020 and November 2023.

In 2022, in response to demand, guidance on managing nutritional issues in cancer was also developed.

The main community and COPD guidance documents are endorsed by key professional and patient organisations. Where applicable, they include formal NICE endorsement statements to support the delivery of NICE guidance and quality standards. They are also cited as part of the supporting evidence in the NICE Clinical Knowledge Summary on adult malnutrition, reinforcing their credibility and widespread use in clinical practice across the NHS.

Our resources also include free, downloadable, patient-focused materials. These offer practical dietary advice to treat and prevent malnutrition, and help manage symptoms — such as poor appetite, fatigue, or swallowing difficulties — that can interfere with eating and quality of life.

In recent years, we have expanded our portfolio to include fully referenced fact sheets and online tools on topics such as: frailty, sarcopenia, dysphagia, falls prevention and nutrition in care homes. These resources highlight the essential role of nutrition in managing and preventing health decline in older adults and those with long-term conditions.

A collaborative approach

We are committed to tackling disease-related malnutrition through collaboration. We actively seek input from like-minded professionals and welcome the sharing of ideas and initiatives through our regular PATHWAY NEWSLETTER

We work in partnership with national organisations including the British Association for Parenteral and Enteral Nutrition (BAPEN), the Malnutrition Task Force and local NHS Trusts. We are grateful to the professional and patient groups that have endorsed our guidance and continue to support its dissemination.

We also thank the companies that have supported our work through unrestricted educational grants. Without this external funding, many of our resources would not be possible.

Our network of professionals

Clinical Director: Dr. Anne Holdoway Anne has over 30 years of experience spanning NHS dietetics, private practice, research, and industry. She was awarded a Fellowship of the British Dietetic Association in 2016 in recognition of her outstanding contribution to the profession. Anne initiated and has chaired the multi-professional Managing Adult Malnutrition in the Community consensus panel since its launch in 2011 and is also chair of the Managing Malnutrition in COPD panel.

Anne plays a leading role in the development of all clinical guidance and patient-facing materials across the Malnutrition Pathway platform. An international speaker on disease-related malnutrition, she recently completed doctoral research exploring the role of nutrition and diet in palliative care. For over a decade, she has worked closely with national bodies, including NICE, BAPEN, the BDA, BSG, and the RCGP, to promote nutrition as a fundamental component of healthcare.

Communications Director: Hilary Franklin Hilary oversees all communications and educational initiatives for the Malnutrition Pathway. She is responsible for coordinating events, managing partnerships, and ensuring alignment with the professional and patient organisations that endorse the materials.

With more than 25 years of experience in healthcare communications, Hilary has led the planning, production, and dissemination of the full suite of guidance and resources available through the Malnutrition Pathway - including patient leaflets, symptom-specific materials, and digital tools. Since the inception of both the Managing Adult Malnutrition in the Community and Managing Malnutrition in COPD initiatives, Hilary has played an integral role in shaping and expanding the resource portfolio, ensuring materials are accessible, relevant, and widely adopted.

Science Director: Dr Abbie Cawood Abbie, a registered nutritionist with a PhD in Clinical Nutrition, brings a wealth of experience to the Malnutrition Pathway team. She is a member of the Institute of Clinical Research and a Visiting Research Fellow at the University of Southampton, with a background spanning both academic and commercial sectors in nutrition, health, and wellness.

After completing her PhD, Abbie specialised in human nutrition research as a post-doctoral research fellow, focusing on both the general population and patients with various diseases. Her career then transitioned into industry, where she has held several medical, science, research, and nutrition roles, while maintaining her academic ties. She is currently Head of Science at Holland and Barrett. Abbie consistently provides scientific input and expertise, contributing significantly to the evidence base of the Malnutrition Pathway materials.

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 was 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.

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