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Ten Years of Tackling Malnutrition in the Community

This week marks the 10th Anniversary of the launch of the Managing Adult Malnutrition in the Community guidance.

Since its launch by a multi-disciplinary consensus panel in 2012, the Malnutrition Pathway website (www.malnutritionpathway.co.uk) has received nearly a quarter of a million visits. In the past year alone, the website has been visited by over 30,000 professionals, patients and carers from over 150 countries around the world. Over 60,000 copies of the Managing Adult Malnutrition in the Community document and nearly 16,000 of the corresponding patient leaflets were downloaded in 2021. Year-on-year growth in visits and downloads, reflects the ongoing need for guidance and resources to help support the 3 million people in the UK who are at risk of malnutrition, 93% of whom live in the community.1

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 ten professional and patient organisations and includes an endorsement statement from the National Institute for Health and Care Excellence (NICE).2

The resources are accessed by a broad range of healthcare professionals in the community, including dietitians, nurses, GPs, pharmacists, physiotherapists, speech and language therapists, healthcare assistants and care homes personnel, to support the identification, treatment and prevention of disease-related malnutrition. Pilot studies have demonstrated a positive impact on patient outcomes and a reduction in healthcare usage through better nutrition.3, 4

Feedback from end-users over the past ten years has facilitated the creation of additional materials, including patient and carer leaflets and new resources focusing on key areas in clinical nutrition such as COPD, COVID-19, cancer and sarcopenia. The website now hosts sections dedicated to specific healthcare professional groups involved in the care of patients at risk of malnutrition. A patient and carer section enables care professionals and patients and family members to easily access resources relevant to them.

“Advancing age and the presence of an acute illness or long-term condition, can have a profound impact on appetite, absorption of nutrients and the ability to source food, prepare meals and consume enough to maintain nutritional status, predisposing an individual to the deleterious effects of malnutrition. Given that health and social care costs for individuals with malnutrition are three to four times more than managing a nourished individual,5 it is crucial that nutritional screening and nutritional care is embedded into clinical care pathways to identify and treat those at risk malnutrition at the earliest opportunity,” says Dr Anne Holdoway, Chair of the Malnutrition Pathway panel. “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 increased risk, enables early action to be taken to improve healthcare outcomes and manage costs. This was the driving force behind the development of the managing adult malnutrition in the community pathway and resources. It has been hugely rewarding to see that, 10 years on, the resource and its updates remain as relevant as when they were initially launched and thus continue to help the health and social care teams provide nutritional care and advice to some of our most vulnerable individuals.”

References: 1. Elia M and Russell CA (2009). Combating Malnutrition: Recommendations for Action. Report from the advisory group on malnutrition, led by BAPEN; 2. The ‘Managing Adult Malnutrition in the Community’ document and supporting patient materials have been supported by 10 key professional and patient associations:
• The British Association For Parenteral And Enteral Nutrition (BAPEN)
• The British Dietetic Association (BDA)
• The British Pharmaceutical Nutrition Group (BPNG)
• The National Nurses Nutrition Group (NNNG)
• The Patients Association
• The Primary Care Society for Gastroenterology (PCSG)
• The Primary Care Pharmacy Association (PCPA)
• The Royal College Of General Practitioners (RCGP)
• The Royal College Of Nursing (RCN)
• The Royal Pharmaceutical Society (RPS).

In addition, 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; 3. Brown F, et al. (2020). Economic impact of implementing malnutrition screening and nutritional management in older adults in general practice. J Nutr Health Aging.; 24(3): 305-311. 4. Cawood A, et al. (2017). Local implementation of a pathway to manage malnourished COPD patients in the community. Eur Respir J.; 50(suppl 61): PA1609.; 5. Elia M, on behalf of the Malnutrition Action Group (BAPEN) and the National Institute for Health Research Southampton Biomedical Research Centre (2015). The cost of malnutrition in England and potential cost savings from nutritional interventions (full report); www.bapen.org.uk/pdfs/economic-report-full.pdf

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