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Managing Adult Malnutrition in the Community

Managing Adult Malnutrition in the Community is a practical, evidence-based guide designed to support healthcare professionals in identifying and managing disease related malnutrition across community care settings.1  The guide was developed by a multi-professional team and endorsed by ten key organisations, including The British Association for Parenteral and Enteral Nutrition (BAPEN) and The British Pharmaceutical Nutrition Group (BPNG).1

The guide outlines a four-step framework to support clinical decision making and optimise patient outcomes through good nutritional care.1

For the full guide, please click here

Patients can be screened opportunistically (e.g. on first contact) or in response to a clinical concern.

Concerns that warrant screening can be varied and can include poor wound healing, apathy, frequent falls, recurrent infections and post-surgery, in addition to the obvious weight loss and poor appetite issues.

For more information on MUST, please click here

Once identified, nutritional risk should be explored further to determine contributing factors and appropriate next steps. These may include the impact of underlying disease issues, medication-related side effects and psychological factors.

Evaluating the causes and symptoms interfering with nutritional intake and addressing those that are either reversible or modifiable can be an integral component of managing any malnutrition issues.

In some cases, referral to relevant specialities may be required.

Management should align with the severity of malnutrition as identified by screening tools like MUST, which classify patients into low, medium, or high-risk categories.

Interventions may include ‘Food First’ strategies, oral nutritional supplements (ONS), or a multivitamin and mineral supplement when micronutrient deficiencies are suspected.

In most cases, malnutrition can be managed using ‘Food First’ – dietary advice to optimise food intake. ONS can be used when dietary intake is insufficient, or when it is anticipated food alone will not meet nutritional requirements.

For full details, please click here.

Monitor progress against goals and modify intervention when appropriate. Consider weight, strength, physical appearance, mood, appetite, ability to perform daily activities vs. goals set.

Monitoring frequency is dependent on nutritional status of patient, care setting, treatment, disease prognosis and organisational policy.

Screening

Early identification is vital to ensure suitable nutritional support is provided to help identify, prevent or reverse malnutrition.2

Nutritional screening is a simple, quick-to-execute tool, and can be used as a first line of action in detecting at-risk patients. It can be implemented as and when required, including on admission to hospital or residential care, as well as an outpatient or when there is clinical concern.2

A validated and widely implemented screening tool, such as the Malnutrition Universal Screening Tool (MUST), can support identification of patients malnourished or at risk of malnutrition.1-4

MUST has been developed to aid in identifying adults who are underweight and at risk of malnutrition, as well as those living with obesity.3 It has been evaluated in hospital wards, outpatient clinics, general practice, the community and in care homes.3

5 steps used in MUST:3,4

  • Gather measurements: height, weight, BMI.
  • If it is not possible to obtain height and weight, alternative measurements can be used.
  • Note unplanned weight loss.
  • Consider the effect of acute disease.
  • Add scores from steps 1, 2 and 3 together to obtain overall risk of malnutrition.
  • Using the management guidelines and/or local policy, form an appropriate care plan.

For further guidance on using MUST, please visit the BAPEN website here.

Want to know more about managing malnutrition?

Please visit our malnutrition hub for further information.

Find out more
  1. Holdoway A, et al (consensus panel). Managing Adult Malnutrition in the Community. 3rd edition, 2021. Available at: www.malnutritionpathway.co.uk​/library/managing_malnutrition.pdf
  2. Serón-Arbeloa, C. Malnutrition Screening and Assessment. Nutrients 2022, 14, 2392. https://doi.org/10.3390/nu14122392
  3. The ‘MUST’ explanatory booklet. A Guide to the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for Adults. BAPEN. Available at: https://www.bapen.org.uk​/pdfs/must/must_explan.pdf
  4. Malnutrition Universal Screening Tool. BAPEN. Available at: https://www.bapen.org.uk​/pdfs/must/must_full.pdf
References accessed February 2026.

Adverse events should be reported. Reporting forms and information can be found at yellowcard.mhra.gov.uk or by searching for MHRA Yellow Card in the Google Play or Apple App Store. Adverse events should also be reported to Pharmacovigilance at Alliance Pharmaceuticals Ltd, Tel: 01249 466966, email: pharmacovigilance@alliancepharma.co.uk.

Please consult the Summary of Product Characteristics for a full listing of contraindications, precautions, and adverse events before prescribing this medicine. Rash, nausea, vomiting and abdominal pain have been reported (frequency not known). Should not be given to individuals with allergies to peanut or soya, hypercalcaemia, haemochromatosis, other iron storage disorders, hypersensitivity to the active substance(s) or to any of the excipients.