Nutritional screening
Nutritional screening is your first step in identifying people at risk of malnutrition. It is essential to screen vulnerable people, including the elderly and those with long-term conditions.
Nestlé HealthCare Nutrition has chosen two validated and easy-to-use screening tools: MUST (Malnutrition Universal Screening Tool) and the MNA® (Mini-Nutritional Assessment Tool) - which has been specifically tailored for your patients who are over 65 years old. Both screening tools should help you establish reliable pathways of care for your patients with malnutrition.
MUST (Malnutrition Universal Screening Tool) - MUST is a quick and simple five-step screening tool, designed by the Malnutrition Advisory Group (MAG), a standing committee of the British Association of Parenteral and Enteral Nutrition (BAPEN). It can be used by all healthcare professionals and has been validated across various settings, like hospital wards, outpatient clinics, general practice, community settings and care homes.
MNA (Mini-Nutritional Assessment Tool) - The MNA is a validated nutrition screening and assessment tool that can help you identify people aged 65 and over who are malnourished or at risk of malnutrition. It is a reliable and easy-to-use nutritional assessment tool that has been developed to assess nutritional status as part of the standard evaluation of elderly patients.
The rationale for nutrition support
Following the identification of patients at risk of malnutrition by screening, there is a need to implement evidence-based treatments.
Food and nutrition intake is fundamental to good health and resistance to disease. In the majority of cases, an adequate dietary intake can be achieved by providing good food, as long as you take care to ensure the appropriate consistency of food is used and physical help with eating is provided when necessary.
Nutrition support involves the provision of nutrition beyond that provided by normal food intake and should be considered for all patients you’ve identified as malnourished or at risk of malnutrition.
Oral nutrition support uses methods to improve nutritional intake: fortified food with protein, carbohydrate and/or fat, plus minerals and vitamins; snacks; oral nutritional supplements; altered meal patterns; the provision of dietary advice.
Artificial feeding, used alone or with food, can be a valuable life-saving method of preventing or treating malnutrition in your community patients. However, many people with malnutrition or at risk of developing malnutrition won’t require artificial feeding and can be better managed using oral feeding. Commonly-used strategies, individually or in combination, include dietary fortification and counselling and oral nutritional supplements (ONS).
The rationale for using ONS
The use of liquid nutritional supplements seem to have minimal effect on appetite and voluntary food intake, i.e. increasing total energy and nutrient intake. Research has shown ONS have little suppressive effect on food intake, with an average of 68% of the energy being additive to food intake. They appear to be most effective in studies in which the BMI of patients is less than 20 kg/m2, which suggests that ONS may be a good treatment of the malnourished (underweight and/or weight-losing) patient.
The efficacy of ONS may be limited if compliance is poor, which can be an issue with long-term supplementation of chronically sick patients in the community.