Synopsis
Detect malnutrition and refeeding risk systematically, identify reversible barriers to eating, and deliver proportionate food-first or oral supplement support with measurable goals and multidisciplinary review.
- Nutritional screening is a repeatable risk-finding process, not a complete dietetic assessment; use a validated tool such as MUST within the setting's agreed timetable.
- MUST combines current body mass index, unplanned weight loss and an acute-disease effect when no intake is expected for more than five days.
- A high body mass index does not protect against malnutrition: oedema obscures weight, and sarcopenia or micronutrient deficiency can coexist with obesity.
Key red flags
A patient with very low intake, major weight loss, low potassium, phosphate or magnesium, or a very low BMI needs immediate refeeding-risk management before unrestricted supplementation.
Investigation priorities
Standardise risk identification and trigger the appropriate local care pathway.
Management branches
Validated screening identifies medium or high risk, or clinical concern overrides a low score.
- Confirm weight history, recent intake, acute illness, swallowing safety, symptoms, function and social access to food.
- Assess refeeding risk and immediate medical instability before recommending rapid nutritional escalation.
Key medicines
Nutritionally complete oral supplementPrescribe the product, volume and daily frequency recommended after dietary assessment, usually between meals rather than as an unplanned meal replacement.
Thiamine with balanced multivitamin supportStart immediately before and during increased feeding in patients meeting refeeding-risk criteria, following the current local protocol.