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Malnutrition Universal Screening Tool

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Version Jan 2023

Related Subjects: | Dementias

Often these issues and their solutions are complex and multifactorial and need a multidisciplinary discussion

Daily reference intakes for adults are

Energy: 8,400kJ/2,000kcal
Total fat: less than 70g
Saturates: less than 20g
Carbohydrate: 260g
Total sugars: 90g
Protein: 50g
Salt: less than 6g

Needing help

BMI is < 18.5
BMI is < 20 with unintentional weight loss of > 5% in the last 3-6 months
If BMI is < 20 with unintentional weight loss of > 10% in the last 3-6 months

General Assessment

Ability to chew (any issues with dentition) and swallowing issues
Total food and drink intake
Physical symptoms e.g. pain, vomiting, constipation, diarrhoea, oral thrush, wound healing
Impact of medication (consider taste changes/any that may suppress appetite)
Medical prognosis (appropriate intervention)
Environmental and social issues, Psychological issues
Substance or alcohol misuse
Is the patient frail and reaching end of life

Treatment goals

These should be documented and agreed with patients.
Goals should be realistic and measurable and may include:
Target weight, target weight gain or target BMI over a period of time
Weight maintenance where weight gain is unrealistic or undesirable
Reduced rate of weight loss where weight maintenance is not realistic (e.g. cancer cachexia, end of life care)
Improvement in oral nutritional intake
Optimising nutritional intake during acute illness
Wound healing if relevant
Biochemical, functional, psychological or behavioural symptoms e.g.improvement in strength, physical appearance, appetite, ability to perform activities of daily living

Step	Action	Action
Step 1	Measure height and weight to get a BMI score using the chart provided. If unable to obtain height and weight, use the alternative procedures shown in this guide.	BMI kg/m2 (weight divided by height squared) Score >20 (>30 Obese)= 0 18.5-20= 1 <18.5= 2
Step 2	Note percentage unplanned weight loss and score using tables provided.	Unplanned weight loss in 3-6 months <5%: 0 5-10%:1 >10%:2
Step 3	Establish acute disease effect and score.	If patient is acutely ill and there has been or is likely to be no nutritional intake for >5 days Score 2
Step 4	Add scores from steps 1, 2 and 3 together to obtain the overall risk of malnutrition.	Add Scores together to calculate overall risk of malnutrition Score 0 Low Risk Score 1 Medium Risk Score 2 or more High Risk
Step 5	Use management guidelines and/or local policy to develop a care plan	0:Low risk - routine clinical care 1:Medium Risk: observe - document intake and continue to monitor 2 or more: High risk so involve dietitian, set goals, ensure nutritional support.

Managing Weight loss

Baseline weight and history of weight, diet sheets recording intake
Exclude dietary intake/dementia/ environmental limits to food, Alcoholism, malabsorption
Able to swallow
- Encourage Oral Intake and offer supplements
- Full fat milk and high calorie food
- Tasty familiar foods, ensure no dental issue
- Consider steroids to boost appetite
- Treat depression - Mirtazepine etc even ECT
- Encourage snacking
- involve family and staff in protecting and supporting feeding time
Unable to swallow (Enteral means uses gut)
- Nasogastric tube (Enteral) is useful as a temporary measure. Risks are still aspiration of gastric contents and resiteing tube in wrong place.
- Percutaneous endoscopic gastrostomy (enteral) usually when feed needed for more than 30 days
Unable to use the Gut
- Parenteral feeding is higher risk with increased risk of significant complications. Enteral should always be the first line for those with a functioning gut. Consider either Central venous line insertion usually via infraclavicular subclavian vein or via via large peripheral line in the mid arm.
Cautions "at risk feeding" in those entering the dying phase. The aim is for comfort and allowing patient to eat and drink as they wish.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. The official launch will be at the end of 2018. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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