Managing Adult Malnutrition
Including a pathway for the appropriate use of
oral nutritional supplements (ONS)
Applying the Manutrition Pathways in practice:
Case Studies
Many adults at risk of malnutrition present with similar signs - unplanned weight loss, reduced appetite, early satiety, fatigue and reduced ability to manage daily activities.
The Malnutrition Pathway provides 3 practical pathways to support adults at risk of malnutrition. The choice of pathway depends on the clinical context, the underlying condition, and the wider picture of physical function and disease burden.
The case studies below show how each of the three practical pathways can be applied in different scenarios to support clinical decision‑making.
Use this pathway when malnutrition occurs in the context of COPD, particularly when:
- breathlessness, early satiety or hyperinflation limit food intake
- COPD progression affects physical function or appetite
Case Study 1 Michael, 72, presents with COPD‑related weight loss, reduced appetite, and increased breathlessness during meals. With dietary advice, high‑energy/high‑protein eating strategies, oral nutritional support, and optimised COPD management, he regains weight and function.
MANAGING MALNUTRITION IN THE COMMUNITY
This pathway is designed for use with adults who are at risk of disease related malnutrition and are living in the community. They may present with:
- unplanned weight loss linked to illness, recovery from acute episodes, or long‑term conditions
- reduced appetite or early satiety affecting nutritional intake
- nutritional decline impacting wound healing, function or wellbeing
Case Study 2 Maya, 81, has an unhealed pressure ulcer alongside significant unintentional weight loss and reduced interest in food following bereavement. Enhanced dietary intake, social support, and oral nutritional supplements help stabilise her weight and support near complete wound healing.
ASSESSING FRAILTY, SARCOPENIA AND MALNUTRITION
Case Study 3 Jean, 71, experiences a fall, rising fatigue, and mild weight loss, with assessments indicating prefrailty and a high risk of sarcopenia. Increased protein intake alongside a structured resistance exercise programme improves strength, stabilises weight, and reduces sarcopenia risk.
Case Study 4 Omar, 80, presents with progressive weight loss, reduced appetite, declining mobility, and multiple frailty related comorbidities. A comprehensive multidisciplinary plan - including dietary optimisation, treatment of reversible causes, physical activity support, and oral nutritional supplements – leads to improvements in weight, appetite, and daily functioning.
Support for Patients & Carers
A number of resources are available that have been developed to support patients and carers.
Specific support for common conditions
A number of resources are available that have been developed to assist healthcare professionals supporting patients at risk of malnutrition as a result of a specific condition. These include:
Further Information
We can be contacted regarding the malnutrition pathway materials and website
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