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Groups At Risk of Malnutrition Include Those With6:

Chronic disease COPD, cancer, inflammatory bowel disease, gastrointestinal disease, renal or liver disease.
Chronic progressive disease Dementia, neurological conditions (Parkinson’s disease, MND).
Acute illness Where food is not being consumed for more than 5 days (this is often seen in the acute setting and is rare in the community).
Debility Frailty, immobility, old age, depression, recent discharge from hospital.
Social issues Poor support, housebound, inability to cook and shop, poverty.

Nutrition Screening

Malnutrition can be identified using a validated screening tool such as the ‘Malnutrition Universal Screening tool’ (‘MUST’)1. For 'MUST' see BAPEN or e-Guidelines websites.

MUST’ is a 5 step screening tool that can be used across care settings to identify adults who are malnourished or at risk of malnutrition. ‘MUST’ includes management guidelines and alternative measures when BMI cannot be obtained by measuring weight and height1.

  • BMI Score
    > 20kg/m2 Score 0
    18.5 - 20kg/m2 Score 1
    < 18.5kg/m2 Score 2
  • Weight Loss Score

    Unplanned weight loss score
    in past 3-6 months

    <5% Score 0
    5 - 10% Score 1
    >10% Score 2
  • Acute disease effect score

    (unlikely to apply outside hospital)

    If patient is acutely ill & there has been or is likely to be no nutritional intake for more than 5 days

    Score 2

Total score 0-6

  • Low Risk - Score 0

    Low Risk - Score 0

    Routine clinical care

    Review/repeat screening monthly in care homes

    Annually in community if BMI > 30kg/m2 (obese) treat according to local policy/national guidelines

    Routine Clinical Care

  • Medium Risk - Score 1

    Medium Risk - Score 1

    Dietary advice to maximise nutritional intake. Record intake for 3 days, encourage small frequent meals and snacks, with high energy and protein food and fluids13.

    Powdered nutritional supplements to be made up with water or milk are available13.

    Review progress/repeat screening after 1-3 months according to clinical condition or sooner if the condition requires.

    If improving continue until 'low risk'.

    If deteriorating, consider treating as 'high risk'.


  • High Risk - Score 2 or more

    High Risk - Score 2 or more

    Dietary advice to maximise nutritional intake. Record intake for 3 days, encourage small frequent meals and snacks, with high energy and protein food and fluids13.

    Prescribe oral nutritional supplements (ONS) and monitor.

    On improvement, consider managing as ‘medium risk’.

    If no improvement or more specialist support is required, refer to dietitian.


* Treat unless detrimental or no benefit is expected from nutritional support.

Recommended screening frequency:

  • First contact within care setting e.g. upon registration with GP, first home visit, on admission to care home or hospital7. Other opportunities for screening include: contact with community pharmacist or district nurse.
  • Upon clinical concern (e.g. unintentional weight loss, appears thin, fragile skin, poor wound healing, pressure ulcers, apathy, wasted muscles, poor appetite, altered taste sensation, impaired swallowing, altered bowel habit, loose fitting clothes or prolonged intercurrent illness) and consider groups at risk of malnutrition.
  • Once an individual has been highlighted at risk of malnutrition, regular screening and monitoring is recommended to determine any improvement or deterioration and action7.

Subjective Indicators of Malnutrition

In the absence of height and weight (measured or recalled), the following subjective indicators** can be used collectively to identify individuals at risk of malnutrition1:

  • Physical appearance e.g. thin or very thin.
  • History of recent unplanned weight loss.
  • Loose fitting clothing/jewellery, need for assistance with feeding, changes in appetite and problems with dentition.
  • Risk of undernutrition due to current illness.
  • Increased nutritional needs as a result of disease.
  • Presence of swallowing difficulties which could impact on ability to eat and drink.
  • The individual’s ability to eat and drink; how does current intake compare with 'normal' intake?

**For more guidance on the use of subjective criteria, see The ‘MUST’ explanatory booklet.

If only using clinical judgement, the following may act as a guide

Malnutrition Risk Physical Appearance
Unlikely to be at risk of malnutrition (low) Not thin, weight stable or gaining weight (no unplanned weight loss), no change to appetite.
Possible risk of malnutrition (medium) Thin as a result of disease/condition or history of unplanned weight loss in previous 3-6 months, reduced appetite/ability to eat.
Likely malnourished (high) Thin/very thin and/or substantial unplanned weight loss in previous 3-6 months.

No oral intake for 5 days in the presence of acute disease (unlikely to be seen in the community).

This section

Overview Identification
Download full document Survey What the experts say
BAPEN 'MUST' Calculator BAPEN 'MUST' App

BMI calculator

Weight loss calculator

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