Managing Adult Malnutrition

Including a pathway for the appropriate use of
oral nutritional supplements (ONS)

Dietary Advice

Links to useful information on Dietary Advice can be found HERE

NICE Guidance (CG3214 and QS2415)

• NICE CG32 recommends considering oral nutrition support to improve nutritional intake for people who can swallow safely and are malnourished or at risk of malnutrition (based on high quality/A-grade evidence)
• NICE QS24 emphasises the need for all care services to take responsibility for the identification of people at risk of malnutrition, to provide nutritional support for everyone who needs it and to take an integrated approach to the provision of services

Dietary advice to optimise nutritional intake

• Check with local dietitian or local policy and guidance
• Give Yellow leaflet - ‘Your Guide to Making the Most of Your Food’
• Advise on adjusting choices of everyday foods (e.g. cheese, full fat milk) added to the diet to increase energy and protein content without increasing volume of food consumed
• Encourage small, frequent meals and snacks with a focus on nutrient rich foods and fluids
• Overcome potential barriers to oral intake: physical (e.g. dentition, illness related loss of appetite, changes in taste), mechanical (e.g. need for modified texture diet/thickened fluids following a swallow assessment) and environmental (e.g. unable to prepare food, financial issues). Consider referral to other healthcare professionals such as a dietitian, occupational therapist, speech and language therapist
• Whilst there is some evidence for managing malnutrition with dietary advice alone, data on clinical outcomes or cost is limited 21
• Care should be taken when using food fortification to ensure that requirements for all nutrients including protein and micronutrients are met 14. Consider a multivitamin and mineral supplement
• Acute and chronic disease may adversely affect appetite and the ability to consume, source and prepare meals and drinks. Dietary advice can only be effective if it is feasible, acceptable and acted on by the individual or carer


Management of malnutrition according to risk category

A screening and management pathway using 'MUST' that can be used across care settings to identify adults who are malnourished or at risk of malnutrition.


Oral Nutritional Supplements: Where individuals require (or already have) a prescription of ONS, this pathway will guide you in setting goals, deciding on dose and duration of ONS, how and when to monitor progress and when to discontinue prescription.


A Guide to Managing Adult Malnutrition in the Community: the complete document is available.



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


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:

COPD LUNG CANCER (external site)

Further Information

We can be contacted regarding the malnutrition pathway materials and website

Register with us for regular updates on managing malnutrition MORE >
Share Best Practice or Testimonials & win an award MORE >
This site is regularly updated with news items on the management of malnutrition.
BMI calculator

Weight loss calculator

If you have a combined BMI and weight loss calculator score of 1 or more please go to
for further information

Privacy Policy Cookie Statement