Introduction
      
        Malnutrition
      
        Assessing malnutrition - MUST
      
        Treatment of malnutrition
        ◦Food first approach
        ◦Practical examples
      
        Appropriate use of oral nutritional 
        supplements
           Malnutrition
        
         A common clinical and public health problem, 
         affecting all ages and all care settings
        Definition: 
        ‘  A state in which a deficiency of nutrients 
         such as energy, protein, vitamins and 
         minerals causes measurable adverse effects 
         on body composition, function or clinical 
         outcome’
            
                       NICE [CG32]– Nutritional Support for Adults, February 2006
     Those at risk of malnutrition:
     Sick, frail and elderly
     Cancer, Stroke
     Acute/chronic pain
     Chronic respiratory disorders, i.e. COPD
     Poor dentitian
     Clinical consequences include:
     Reduced muscle strength
     Impaired wound healing
     Longer recovery from illness/surgery
     Poorer clinical outcomes
     More frequent GP visits and hospital 
       admissions
              Facts
           
            In 2010, 34% of hospital in-patients on 
            admission were medium/high risk of malnutrition
           
            93% of those at risk from malnutrition, live in the 
            community
           
            Malnutrition costs £13b per year and affects at 
            least 2 million people in the UK
           
            Effective and regular screening to identify 
            malnutrition or risk of malnutrition is essential
               Tackling malnutrition can improve 
             nutritional status, clinical outcomes 
                     and reduce health care use
                                                                         BAPEN, 2010
       Malnutrition Universal Screening 
       Tool (‘MUST’)
     
      What is ‘MUST’?
      ◦A five-step malnutrition screening tool 
       for adults in hospital and the 
       community, including care homes, 
       outpatient clinics and general practice
     
      What does ‘MUST’ do?
      ◦Identify those who may be malnourished 
       or at risk of malnutrition
        MUST Score of:  0 – low risk
                 1 – medium risk
                 2 or above – high risk