This year marks the 10-year anniversary of the launch of the Managing Adult Malnutrition in the Community guidance. Since its launch by a multidisciplinary consensus panel in 2012, the Malnutrition Pathway website (www.malnutritionpathway.co.uk) has received nearly a quarter of a million visits and has seen year-on-year growth in visits and downloads, demonstrating the need for guidance to treat the 3 million people in the UK who are at risk of malnutrition, 93% of whom live in the community (Elia and Russell, 2009; Elia, 2015). In the past year alone the Malnutrition Pathway website has been visited by over 30 000 professionals, patients and carers from over 150 countries around the world. More than 60 000 copies of the Managing Adult Malnutrition in the Community document (Holdoway et al, 2021) and nearly 16 000 of the corresponding patient leaflets were downloaded in 2021.
The guidance document was developed to assist non-nutrition experts in the identification, treatment and prevention of disease-related malnutrition in the community. Now in its third iteration, the Managing Adult Malnutrition in the Community document has received consistent endorsement from 10 professional and patient organisations and includes an endorsement statement from the National Institute for Health and Care Excellence (NICE) (see Box 1).
Box 1.EndorsementThe Managing Adult Malnutrition in the Community document and supporting patient materials have been supported by 10 key professional and patient associations:
- British Association for Parenteral and Enteral Nutrition (BAPEN)
- British Dietetic Association (BDA)
- British Pharmaceutical Nutrition Group (BPNG)
- National Nurses Nutrition Group (NNNG)
- Patients Association
- Primary Care Society for Gastroenterology (PCSG)
- Primary Care Pharmacy Association (PCPA)
- Royal College of General Practitioners (RCGP)
- Royal College of Nursing (RCN)
- Royal Pharmaceutical Society (RPS)
The guidance also includes the following NICE endorsement statement:This booklet supports the implementation of recommendations in the NICE guideline on nutrition support for adults. It also supports statements 1, 2 and 5 in the NICE quality standard for nutrition support in adults.National Institute for Health and Care Excellence Endorsed December 2017. Updated June 2021
The resources are accessed by a broad range of health professionals in the community, including nurses, to support the identification, treatment and prevention of disease-related malnutrition and pilot studies have demonstrated a positive impact on patient outcomes and healthcare resource usage (Cawood et al, 2017; Brown et al, 2020).
Feedback from end-users over the past 10 years has facilitated the creation of additional materials including patient and carer leaflets and resources focusing on such areas as chronic obstructive pulmonary disease, cancer, sarcopenia and COVID-19. The website now also hosts specific sections to support health professional groups involved in the care of patients at risk of malnutrition, as well as a patients and carers section to enable easy access to resources relevant to them.
The clinical consequences of malnutrition include impaired immune response, reduced muscle strength, impaired wound healing and increased falls. Malnourished individuals have more hospital admissions/readmissions, longer length of hospital stay and greater primary care healthcare needs, therefore identification and management is key. Groups at high risk of malnutrition include older people, those recently discharged from hospital, those with chronic disease, progressive neurological disease, acute illness, frailty, undergoing rehabilitation or receiving end-of-life or palliative care.
Advancing age and the presence of an acute illness or long-term condition can predispose individuals to malnutrition as a result of older age alone, or in combination with disease disrupting appetite and interfering with the ability to prepare, eat, drink and absorb food. Given that individuals with malnutrition cost three to four times more than managing nourished individuals (Elia, 2015) it is crucial that nutritional screening and nutritional care is embedded into clinical care pathways to identify and treat those at risk of malnutrition at the earliest opportunity. The expertise of dietitians in assessing patients with nutritional issues and providing bespoke advice is not to be underestimated but as a relatively small workforce we cannot currently treat everyone. Transferring knowledge and skills and providing tools and resources to empower members of the healthcare team to look for malnutrition, especially in those at risk, to enable early action to be taken to improve healthcare outcomes and manage costs was the driving force behind the development of the pathway and resources. It has been hugely rewarding to see that, 10 years on, the resource and its updates remain as relevant today as when they were initially launched and thus continue to help health and social care teams provide nutritional care and advice to some of our most vulnerable individuals.