"...all doctors should be able to diagnose and treat nutritional deficiencies."

Royal College of Physicians. Nutrition and Patients: A Doctor's Responsibility. London 2002

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NICE Guidelines - Nutrition Support in Adults

The National Institute for Health and Clinical Excellence, NICE, has published clear guidelines in February 2006 Nutritional Support in Adults for doctors, nutritionists and other healthworkers to help identify and treat those who are or are most at risk of being nutritionally deficient. www.nice.org.uk/CG032

The guidelines recognise that “… the knowledge of the causes, effects and treatment of malnutrition among healthcare professionals in the UK is poor.  The purpose of the guidelines is to help healthcare professionals correctly identify people in hospital and the community who need nutrition support, and enable them to choose and deliver the most appropriate nutrition support at the most appropriate time.”

A four stage process is outlined consisting of screening, recognising, treating and monitoring.

The report identifies that both in- and out-patients should be screened as is considered clinically appropriate and that:  

  • Nutrition support should be considered in people who are malnourished, as defined by any of the following:
    • A body mass index (BMI) of less than 18.5kg/m2.
    • Unintentional weight loss greater than 10% within the last 3 – 6 months.
    • A BMI of less than 20kg/m2 and unintentional weight loss greater than 5% within the last 3 – 6 months.
  • Nutrition support should be considered in people at risk of malnutrition, defined as those who have:
    • Eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for 5 days or longer
    • A poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism

To see if either of these situations apply to you check:

Those who fulfil the criteria for malnutrition as given above should consult with their doctor or a qualified nutritionist if they have not already done so. 

Further assessment and treatment options can then be decided upon and may include nutrition support by use of dietary advice, fortified feeds or, in the case of hospital-based patients, use of enteral or parenteral treatments.

The NICE guidelines give detailed and excellent advice for professionals on the identification, treatment and monitoring of those with nutritional deficiencies particularly in hospital settings and this document should set the standard for such patients in the UK. 

The guidelines are due for review between 2010 and 2012.



Copyright Dr. Alan Stewart M.B.B.S.M.R.C.P. (UK)M.F. Hom.
47 Priory Street, Lewes, East Sussex. BN7 1HJ
Tel 01273 487003 Fax: 01273 487576