Patient in own home Community Malnutrition Screening Tool (Adults) based on the Malnutrition Universal Screening Tool ( MUST )

Step 1 (Use page 2/3 for BMI score) BMI kg/m 2 Great Western Hospitals Patient in own home Community Malnutrition Screening Tool (Adults) based on the Malnutrition Universal Screening Tool ( MUST ) + Step 2 + More than score = 0 (More than = Obese).5 - score = 1 Less than.5 score = 2 (Use page 5 for score) Unplanned % in past 3-6 months Less than 5% score = 0 5-10% score = 1 More than 10% score = 2 NHS Foundation Trust Step 4 Overall risk of malnutrition Add scores together to give overall risk of malnutrition and complete FOOD is a MUST screening record Step 5 Management guidelines for each score Step 3* Acute disease effect score If patient is acutely ill and there has been or is likely to be no nutritional intake for more than 5 days Score 2* * Rarely needed in the community Note specific concerns Re-feeding Risk: Those who have eaten little or nothing for 5 days or more should have nutritional support introduced gradually and be monitored closely. Those at high risk of malnutrition on MUST may be at risk of re-feeding syndrome. Refer to page of CG Nutrition support in adults: quick reference guide on www.nice.org.uk for further information. Dysphagia: Individuals with signs of dysphagia require further investigation, refer to Speech and Language Therapy. = Low Risk Record aims of treatment and actions on FOOD is a MUST screening record Consider healthy diet information For printable information on healthy eating or, go to: www.bda. uk.com/foodfacts Score 1 = Medium Risk = FOOD FIRST Record aims of treatment and actions on FOOD is a MUST screening record** Complete FOOD is a MUST care plan Manage factors which affect food intake*** Follow the FOOD FIRST approach for improving nutrition (see page 6): Provide Food First advice for improving nutrition leaflet Encourage fortified food and 2 nourishing drinks and 2 nourishing snacks daily between meals Advise a daily multivitamin and mineral Score 2 or more = High Risk = FOOD FIRST Record aims of treatment and actions on FOOD is a MUST screening record** Complete FOOD is a MUST care plan Manage factors which affect food intake*** Follow the FOOD FIRST approach for improving nutrition (see page 6): Provide Food First advice for improving nutrition leaflet Encourage fortified food and 2 nourishing drinks and 2 nourishing snacks daily between meals Advise a daily multivitamin and mineral If patient cannot implement Food First advice, consider following Score 2 or more on review box Repeat MUST Monthly on REVIEW Reduce then discontinue ONS. Return to normal, balanced diet. If still concerned about adequacy of nutritional intake Continue multivitamin and mineral. Score 1 on REVIEW Continue with FOOD FIRST approach and complete review on FOOD is a MUST care plan, repeat MUST monthly. If deteriorating or ongoing concerns Consider treating as high risk (see Score 2 or more on review box). Score 2 or more on REVIEW**** If weight stable or increased in the last month Continue with FOOD FIRST approach and complete review on FOOD is a MUST care plan, repeat MUST monthly. If weight decreased in the last month or unable to implement FOOD FIRST advice Contact GP to request a review. Ask GP to start 2 x first line oral nutritional supplements (ONS) daily. Trial for 2 weeks, check acceptability and try other types and flavours if necessary before issuing a monthly prescription# If weight decreasing after 1 month on ONS Ask GP to refer to Dietitian for further advice**** ** Aims of treatment could include weight maintenance or gain, improved nutritional intake, wound healing, pressure area care, improvements in psychological health and improvements in physical health. *** Factors which may affect appetite include nausea and/or vomiting, constipation or diarrhoea, medication, alcohol and drug use, social concerns (ability to shop, cook and eat) and availability of suitable meals. **** Unless detrimental or no benefit expected from nutritional support, e.g. terminal stage of illness. # Guideline for Prescribing Oral Nutritional Supplements (ONS) for Adults in the Community The Malnutrition Universal Screening Tool ( MUST ) is adapted and reproduced here with the kind permission of BAPEN (British Association for Parenteral and Enteral Nutrition). For further information on MUST see www.bapen.org.uk 1

(kg) (kg) Step 1 BMI score (& BMI) Height (feet and inches) 4'9½ 4'9½ 4'10½ 4'11 5'0 5'0½ 5'1½ 5'2 5'3 5'4 5'4½ 5'5½ 5'6 5'7 5'7½ 5'8½ 5'9½ 5'10 5'11 5'11½ 6'0½ 6'1 6'2 6'3 6'3½ 6'4½ 100 100 47 47 46 46 44 44 43 43 42 42 99 99 46 46 45 45 44 44 43 43 42 42 98 98 46 46 45 45 44 44 42 42 97 97 46 46 44 44 43 43 42 42 96 96 45 45 44 44 43 43 42 42 95 95 45 45 43 43 42 42 94 94 44 44 43 43 42 42 93 93 44 44 42 42 92 92 43 43 42 42 91 91 43 43 42 42 90 90 42 42 89 89 42 42 88 88 87 87 86 86 85 85 84 84 83 83 82 82 81 81 80 80 79 79 78 78 77 77 76 76 75 75 74 74 73 73 72 72 71 71 70 70 69 69 68 68 67 67 66 66 65 17 65 64 17 17 17 64 63 17 17 17 17 17 63 62 17 17 17 17 16 17 62 61 17 17 17 17 17 16 16 61 60 17 17 17 17 17 16 17 16 16 60 59 17 17 17 17 17 16 17 16 16 16 16 59 58 17 17 17 16 17 16 16 16 16 15 16 58 57 17 17 16 17 16 16 16 16 15 16 15 15 57 56 17 17 17 16 16 16 16 15 15 15 15 56 55 17 17 17 16 17 16 16 15 16 15 15 15 15 554 17 17 17 16 17 16 16 15 16 15 15 15 14 15 54 53 17 17 16 17 16 16 15 16 15 15 14 15 14 14 53 52 17 17 16 17 16 16 15 16 15 15 14 15 14 14 14 52 51 17 17 16 17 16 16 15 16 15 15 14 15 14 14 14 14 51 50 17 17 17 16 16 15 16 15 15 14 15 14 14 14 13 14 50 49 17 17 17 17 16 16 15 16 15 15 14 15 14 14 14 13 14 13 49 48 17 17 17 17 16 16 15 16 15 15 14 15 14 14 14 13 14 13 13 48 47 2 17 17 17 17 16 16 16 15 15 15 14 14 14 13 14 13 13 12 13 47 46 17 17 17 16 16 16 16 15 15 15 14 15 14 14 13 14 13 13 12 13 12 46 45 2 17 17 17 16 16 16 16 15 15 15 14 15 14 14 13 14 13 13 12 13 12 12 45 44 17 17 17 16 16 16 16 15 15 15 14 15 14 14 13 14 13 13 12 13 12 12 12 443 17 17 17 16 16 16 16 15 15 15 15 14 14 14 13 14 13 13 12 13 12 12 12 11 12 43 42 17 17 17 16 16 16 16 15 15 15 15 14 14 14 13 14 13 13 12 13 12 12 12 11 12 11 42 17 17 17 16 16 16 16 15 15 15 15 14 14 14 13 14 13 13 12 13 12 12 12 11 12 11 11 17 17 17 16 16 16 16 15 15 15 15 14 14 14 14 13 13 13 12 13 12 12 12 11 12 11 11 11 17 17 17 17 16 16 16 16 15 15 15 15 14 14 14 13 14 13 13 13 12 13 12 12 12 11 12 11 11 11 10 11 17 17 17 17 16 16 16 16 16 15 15 15 14 15 14 14 14 13 13 13 13 12 13 12 12 11 12 11 12 11 11 11 10 11 10 10 17 17 17 17 16 16 16 16 16 16 15 15 15 14 14 14 14 13 13 13 13 13 12 12 12 11 12 11 11 11 10 11 10 11 10 10 10 10 17 17 17 16 16 16 16 16 16 15 15 15 15 14 14 14 14 13 13 13 13 12 13 12 12 12 11 12 11 11 11 10 11 10 10 10 10 10 10 17 16 16 16 16 16 16 15 15 15 15 14 14 14 14 13 13 13 13 12 12 12 12 11 12 11 11 11 10 11 10 10 10 10 910 910 16 16 16 16 16 15 15 15 15 14 14 14 14 14 14 13 13 13 13 12 12 12 12 11 12 11 11 11 10 11 10 11 10 10 10 910 9 9 16 15 16 15 15 15 15 14 14 14 14 14 14 13 13 13 13 13 12 12 12 12 11 11 11 11 10 11 10 10 10 10 10 9 9 9 9 15 15 15 15 15 14 14 14 14 13 14 13 13 13 13 13 13 12 12 12 12 11 11 11 11 10 11 10 10 10 10 9 10 9 9 9 9 9 15 15 15 14 14 14 14 13 13 13 13 13 13 12 13 12 12 12 12 12 11 11 11 11 10 11 10 10 10 10 10 9 9 9 9 9 89 89 15 14 14 14 14 13 13 13 13 13 13 12 12 12 12 12 12 11 12 11 11 11 11 10 10 10 10 10 9 10 9 9 9 9 89 89 8 8 14 1.46 14 1.48 13 1.50 13 1.52 1.54 13 1.56 12 1.58 12 1.60 12 1.62 11 1.64 11 1.66 11 1.68 11 1.70 10 1.72 10 1.74 10 1.76 10 1.78 9 1.80 9 1.82 9 1.84 9 1.86 9 1.88 8 1.90 8 1.92 8 1.94 8 1.46 1.48 1.50 1.52 1.54 1.56 1.58 1.60 1.62 1.64 1.66Height 1.68 1.70 1.72 1.74 1.76 1.78 1.80 1.82 1.84 1.86 1.88 1.90 1.92 1.94 BAPEN Height BAPEN Note : The black lines denote the exact cut off points (, and.5 kg/m 2 ), figures on the chart have been rounded to the nearest whole number. (obese) (obese) Score 1 Score 1 Score 2 Score 2 Note : The black lines denote the exact cut off points (, and.5 kg/m 2 ), figures on the chart have been rounded to the nearest whole number. 2 (stones (stones and and pounds) pounds) BMI chart reproduced with the kind permission of BAPEN

(kg) (kg) Step 1 BMI score (& BMI) Height (feet and inches) 4'9½ 4'10½ 4'11 5'0 5'0½ 5'1½ 5'2 5'3 5'4 5'4½ 5'5½ 5'6 5'7 5'7½ 5'8½ 5'9½ 5'10 5'11 5'11½ 6'0½ 6'1 6'2 6'3 6'3½ 6'4½ Height (feet and inches) 170 80 78 76 74 72 70 68 66 65 63 62 60 59 57 56 55 54 52 51 50 49 48 47 46 45 11 169 79 77 75 73 71 69 68 66 64 63 61 60 58 57 56 55 53 52 51 50 49 48 47 46 45 9 4'9½ 4'10½ 4'11 5'0 5'0½ 5'1½ 5'2 5'3 5'4 5'4½ 5'5½ 5'6 5'7 5'7½ 5'8½ 5'9½ 5'10 5'11 5'11½ 6'0½ 6'1 6'2 6'3 6'3½ 6'4½ 168 79 77 75 73 71 69 67 66 64 62 61 60 58 57 55 54 53 52 51 50 49 48 47 46 45 6 170 80 78 76 74 72 70 68 66 65 63 62 60 59 57 56 55 54 52 51 50 49 48 47 46 45 11 167 78 76 74 72 70 69 67 65 64 62 61 59 58 56 55 54 53 52 50 49 48 47 46 45 44 4 169 79 77 75 73 71 69 68 66 64 63 61 60 58 57 56 55 53 52 51 50 49 48 47 46 45 9 166 78 76 74 72 70 68 66 65 63 62 60 59 57 56 55 54 52 51 50 49 48 47 46 45 44 2 168 79 77 75 73 71 69 67 66 64 62 61 60 58 57 55 54 53 52 51 50 49 48 47 46 45 6 165 77 75 73 71 70 68 66 64 63 61 60 58 57 56 54 53 52 51 50 49 48 47 46 45 44 0 167 78 76 74 72 70 69 67 65 64 62 61 59 58 56 55 54 53 52 50 49 48 47 46 45 44 4 164 77 75 73 71 69 67 66 64 62 61 60 58 57 55 54 53 52 51 50 48 47 46 45 44 44 12 166 78 76 74 72 70 68 66 65 63 62 60 59 57 56 55 54 52 51 50 49 48 47 46 45 44 2 163 76 74 72 71 69 67 65 64 62 61 59 58 56 55 54 53 51 50 49 48 47 46 45 44 43 9 165 77 75 73 71 70 68 66 64 63 61 60 58 57 56 54 53 52 51 50 49 48 47 46 45 44 0 162 76 74 72 70 68 67 65 63 62 60 59 57 56 55 54 52 51 50 49 48 47 46 45 44 43 7 164 77 75 73 71 69 67 66 64 62 61 60 58 57 55 54 53 52 51 50 48 47 46 45 44 44 12 161 76 74 72 70 68 66 64 63 61 60 58 57 56 54 53 52 51 50 49 48 47 46 45 44 43 5 163 76 74 72 71 69 67 65 64 62 61 59 58 56 55 54 53 51 50 49 48 47 46 45 44 43 9 160 75 73 71 69 67 66 64 63 61 59 58 57 55 54 53 52 50 49 48 47 46 45 44 43 43 3 162 76 74 72 70 68 67 65 63 62 60 59 57 56 55 54 52 51 50 49 48 47 46 45 44 43 7 159 75 73 71 69 67 65 64 62 61 59 58 56 55 54 53 51 50 49 48 47 46 45 44 43 42 1 161 76 74 72 70 68 66 64 63 61 60 58 57 56 54 53 52 51 50 49 48 47 46 45 44 43 5 158 74 72 70 68 67 65 63 62 60 59 57 56 55 53 52 51 50 49 48 47 46 45 44 43 42 12 160 75 73 71 69 67 66 64 63 61 59 58 57 55 54 53 52 50 49 48 47 46 45 44 43 43 3 157 74 72 70 68 66 65 63 61 60 58 57 56 54 53 52 51 50 48 47 46 45 44 43 43 42 10 159 75 73 71 69 67 65 64 62 61 59 58 56 55 54 53 51 50 49 48 47 46 45 44 43 42 1 156 73 71 69 68 66 64 62 61 59 58 57 55 54 53 52 50 49 48 47 46 45 44 43 42 8 158 74 72 70 68 67 65 63 62 60 59 57 56 55 53 52 51 50 49 48 47 46 45 44 43 42 12 155 73 71 69 67 65 64 62 61 59 58 56 55 54 52 51 50 49 48 47 46 45 44 43 42 6 157 74 72 70 68 66 65 63 61 60 58 57 56 54 53 52 51 50 48 47 46 45 44 43 43 42 10 154 72 70 68 67 65 63 62 60 59 57 56 55 53 52 51 50 49 48 46 45 45 44 43 42 4 156 73 71 69 68 66 64 62 61 59 58 57 55 54 53 52 50 49 48 47 46 45 44 43 42 8 153 72 70 68 66 65 63 61 60 58 57 56 54 53 52 51 49 48 47 46 45 44 43 42 42 1 155 73 71 69 67 65 64 62 61 59 58 56 55 54 52 51 50 49 48 47 46 45 44 43 42 6 152 71 69 68 66 64 62 61 59 58 57 55 54 53 51 50 49 48 47 46 45 44 43 42 13 154 72 70 68 67 65 63 62 60 59 57 56 55 53 52 51 50 49 48 46 45 45 44 43 42 4 151 71 69 67 65 64 62 60 59 58 56 55 54 52 51 50 49 48 47 46 45 44 43 42 11 153 72 70 68 66 65 63 61 60 58 57 56 54 53 52 51 49 48 47 46 45 44 43 42 42 1 150 70 68 67 65 63 62 60 59 57 56 54 53 52 51 50 48 47 46 45 44 43 42 42 9 152 71 69 68 66 64 62 61 59 58 57 55 54 53 51 50 49 48 47 46 45 44 43 42 13 149 70 68 66 64 63 61 60 58 57 55 54 53 52 50 49 48 47 46 45 44 43 42 6 151 71 69 67 65 64 62 60 59 58 56 55 54 52 51 50 49 48 47 46 45 44 43 42 11 148 69 68 66 64 62 61 59 58 56 55 54 52 51 50 49 48 47 46 45 44 43 42 4 150 70 68 67 65 63 62 60 59 57 56 54 53 52 51 50 48 47 46 45 44 43 42 42 9 147 69 67 65 64 62 60 59 57 56 55 53 52 51 50 49 47 46 45 44 43 42 42 2 149 70 68 66 64 63 61 60 58 57 55 54 53 52 50 49 48 47 46 45 44 43 42 6 146 68 67 65 63 62 60 58 57 56 54 53 52 51 49 48 47 46 45 44 43 42 0 148 69 68 66 64 62 61 59 58 56 55 54 52 51 50 49 48 47 46 45 44 43 42 4 145 68 66 64 63 61 60 58 57 55 54 53 51 50 49 48 47 46 45 44 43 42 12 147 69 67 65 64 62 60 59 57 56 55 53 52 51 50 49 47 46 45 44 43 42 42 2 144 68 66 64 62 61 59 58 56 55 54 52 51 50 49 48 46 45 44 43 43 42 9 146 68 67 65 63 62 60 58 57 56 54 53 52 51 49 48 47 46 45 44 43 42 0 143 67 65 64 62 60 59 57 56 54 53 52 51 49 48 47 46 45 44 43 42 7 145 68 66 64 63 61 60 58 57 55 54 53 51 50 49 48 47 46 45 44 43 42 12 142 67 65 63 61 60 58 57 55 54 53 52 50 49 48 47 46 45 44 43 42 5 144 68 66 64 62 61 59 58 56 55 54 52 51 50 49 48 46 45 44 43 43 42 9 1 66 64 63 61 59 58 56 55 54 52 51 50 49 48 47 46 45 44 43 42 3 143 67 65 64 62 60 59 57 56 54 53 52 51 49 48 47 46 45 44 43 42 7 1 66 64 62 61 59 58 56 55 53 52 51 50 48 47 46 45 44 43 42 1 142 67 65 63 61 60 58 57 55 54 53 52 50 49 48 47 46 45 44 43 42 5 1 65 63 62 60 59 57 56 54 53 52 50 49 48 47 46 45 44 43 42 12 1 66 64 63 61 59 58 56 55 54 52 51 50 49 48 47 46 45 44 43 42 3 1 65 63 61 60 58 57 55 54 53 51 50 49 48 47 46 45 44 43 42 10 1 66 64 62 61 59 58 56 55 53 52 51 50 48 47 46 45 44 43 42 1 1 64 63 61 59 58 56 55 54 52 51 50 49 47 46 45 44 43 42 8 1 65 63 62 60 59 57 56 54 53 52 50 49 48 47 46 45 44 43 42 12 1 64 62 60 59 57 56 54 53 52 51 49 48 47 46 45 44 43 42 6 1 65 63 61 60 58 57 55 54 53 51 50 49 48 47 46 45 44 43 42 10 1 63 62 60 58 57 55 54 53 51 50 49 48 47 46 45 44 43 42 4 1 64 63 61 59 58 56 55 54 52 51 50 49 47 46 45 44 43 42 8 1 63 61 60 58 57 55 54 52 51 50 49 47 46 45 44 43 42 1 1 64 62 60 59 57 56 54 53 52 51 49 48 47 46 45 44 43 42 6 1 62 61 59 58 56 55 53 52 51 49 48 47 46 45 44 43 42 13 1 63 62 60 58 57 55 54 53 51 50 49 48 47 46 45 44 43 42 4 1 62 60 59 57 56 54 53 52 50 49 48 47 46 45 44 43 42 11 1 63 61 60 58 57 55 54 52 51 50 49 47 46 45 44 43 42 1 1 61 60 58 57 55 54 52 51 50 49 48 46 45 44 43 42 9 1 62 61 59 58 56 55 53 52 51 49 48 47 46 45 44 43 42 13 1 61 59 58 56 55 53 52 51 50 48 47 46 45 44 43 42 7 1 62 60 59 57 56 54 53 52 50 49 48 47 46 45 44 43 42 11 1 61 59 57 56 54 53 52 50 49 48 47 46 45 44 43 42 4 1 61 60 58 57 55 54 52 51 50 49 48 46 45 44 43 42 9 1 60 58 57 55 54 53 51 50 49 48 46 45 44 43 42 2 1 61 59 58 56 55 53 52 51 50 48 47 46 45 44 43 42 7 1 60 58 56 55 54 52 51 50 48 47 46 45 44 43 42 0 1 61 59 57 56 54 53 52 50 49 48 47 46 45 44 43 42 4 1 59 58 56 55 53 52 50 49 48 47 46 45 44 43 42 12 1 60 58 57 55 54 53 51 50 49 48 46 45 44 43 42 2 1 59 57 56 54 53 51 50 49 48 46 45 44 43 42 10 1 60 58 56 55 54 52 51 50 48 47 46 45 44 43 42 0 1 58 57 55 54 52 51 50 48 47 46 45 44 43 42 7 1 59 58 56 55 53 52 50 49 48 47 46 45 44 43 42 12 1 58 56 55 53 52 51 49 48 47 46 45 44 43 42 5 1 59 57 56 54 53 51 50 49 48 46 45 44 43 42 10 1 57 56 54 53 51 50 49 48 46 45 44 43 42 3 1 58 57 55 54 52 51 50 48 47 46 45 44 43 42 7 1 57 55 54 52 51 50 48 47 46 45 44 43 42 1 1 58 56 55 53 52 51 49 48 47 46 45 44 43 42 5 1 56 55 53 52 51 49 48 47 46 45 44 43 42 13 1 57 56 54 53 51 50 49 48 46 45 44 43 42 3 1 56 54 53 52 50 49 48 46 45 44 43 42 10 1 57 55 54 52 51 50 48 47 46 45 44 43 42 1 1 55 54 52 51 50 48 47 46 45 44 43 42 8 1 56 55 53 52 51 49 48 47 46 45 44 43 42 13 117 55 53 52 51 49 48 47 46 45 44 42 6 1 56 54 53 52 50 49 48 46 45 44 43 42 10 116 54 53 52 50 49 48 46 45 44 43 42 4 1 55 54 52 51 50 48 47 46 45 44 43 42 8 115 54 53 51 50 48 47 46 45 44 43 42 2 117 55 53 52 51 49 48 47 46 45 44 42 6 114 53 52 51 49 48 47 46 45 43 42 17 13 116 54 53 52 50 49 48 46 45 44 43 42 4 113 53 52 50 49 48 46 45 44 43 42 17 11 115 54 53 51 50 48 47 46 45 44 43 42 2 112 53 51 50 48 47 46 45 44 43 42 17 9 114 53 52 51 49 48 47 46 45 43 42 17 13 111 52 51 49 48 47 46 44 43 42 17 7 113 53 52 50 49 48 46 45 44 43 42 17 11 110 52 50 49 48 46 45 44 43 42 17 5 112 53 51 50 48 47 46 45 44 43 42 17 9 109 51 50 48 47 46 45 44 43 42 17 2 111 52 51 49 48 47 46 44 43 42 17 7 108 51 49 48 47 46 44 43 42 17 0 110 52 50 49 48 46 45 44 43 42 17 5 107 50 49 48 46 45 44 43 42 16 12 109 51 50 48 47 46 45 44 43 42 17 2 106 50 48 47 46 45 44 42 16 10 108 51 49 48 47 46 44 43 42 17 0 105 49 48 47 45 44 43 42 16 7 107 50 49 48 46 45 44 43 42 16 12 104 49 47 46 45 44 43 42 16 5 106 50 48 47 46 45 44 42 16 10 103 48 47 46 45 43 42 16 3 105 49 48 47 45 44 43 42 16 7 102 48 47 45 44 43 42 16 1 104 49 47 46 45 44 43 42 16 5 101 47 46 45 44 43 42 15 13 103 48 47 46 45 43 42 16 3 100 47 46 44 43 42 15 10 102 48 47 45 44 43 42 16 1 1.46 1.48 1.5 1.52 1.54 1.56 1.58 1.6 1.62 1.64 1.66 1.68 1.7 1.72 1.74 1.76 1.78 1.8 1.82 1.84 1.86 1.88 1.9 1.92 1.94 101 47 46 45 44 43 42 15 13 100 47 46 44 43 42 Height BAPEN 15 BAPEN 10 1.46 1.48 1.5 1.52 1.54 1.56 1.58 1.6 1.62 1.64 1.66 1.68 1.7 1.72 1.74 1.76 1.78 1.8 1.82 1.84 1.86 1.88 1.9 1.92 1.94 Note : The black lines denote the exact cut off points (, and.5 kg/m 2 ), figures on the chart have been rounded to the nearest whole BAPEN number. BAPEN Score (obese) 0 (obese) Height Note : The black lines denote the exact cut off points (, and.5 kg/m 3 2 ), figures on the chart have been rounded to the nearest whole number. (stones (stones and pounds) and pounds) BMI chart reproduced with the kind permission of BAPEN

Alternative Measurements If height cannot be measured use recently documented or self-reported height (if reliable and realistic) OR use ulna length to estimate height (see below). If height and weight cannot be obtained use mid upper arm circumference (MUAC) measurement to estimate BMI category (see below). MUAC is not designed to generate a score. If recent cannot be calculated use self-reported (if deemed reliable and realistic). Estimating height from ulna length Men (less than 65 years) 1.94 1.93 1.91 1.89 1.87 1.85 1.84 1.82 1.80 1.78 1.76 1.75 1.73 1.71 Men (more than 65 years) 1.87 1.86 1.84 1.82 1.81 1.79 1.78 1.76 1.75 1.73 1.71 1.70 1.68 1.67 Ulna length (cm).0.5.0.5.0.5.0.5.0.5.0.5.0.5 Women (less than 65 years) 1.84 1.83 1.81 1.80 1.79 1.77 1.76 1.75 1.73 1.72 1.70 1.69 1.68 1.66 Women (more than 65 years) 1.84 1.83 1.81 1.79 1.78 1.76 1.75 1.73 1.71 1.70 1.68 1.66 1.65 1.63 Measure between the point of the elbow (olecranon process) and the midpoint of the prominent bone of the wrist (styloid process) (left side if possible). Decontaminate tape measure after use. Mid upper arm circumference (MUAC) measurement to estimate BMI category Subjective Criteria Men (less than 65 years) 1.69 1.67 1.66 1.64 1.62 1.60 1.58 1.57 1.55 1.53 1.51 1.49 1.48 1.46 Men (more than 65 years) 1.65 1.63 1.62 1.60 1.59 1.57 1.56 1.54 1.52 1.51 1.49 1.48 1.46 1.45 Ulna length (cm).0.5.0.5.0.5.0.5.0.5.0.5.0.5 Women (less than 65 years) 1.65 1.63 1.62 1.61 1.59 1.58 1.56 1.55 1.54 1.52 1.51 1.50 1.48 1.47 Women (more than 65 years) 1.61 1.60 1.58 1.56 1.55 1.53 1.52 1.50 1.48 1.47 1.45 1.44 1.42 1. Bend the patient s left arm at the elbow at a 90 degree angle with the upper arm held parallel to the side of the body. Measure the distance between the bony protrusion on the shoulder (acromion) and the point of the elbow (olecranon process). Mark the mid-point. With the patient s left arm hanging loose, measure around the upper arm at the marked mid-point. Ensure that the tape measure is snug, but not tight. Decontaminate tape measure after use. If MUAC is less than.5cm, BMI is likely to be less than kg/m 2. If MUAC is greater than.0cm, BMI is likely to be greater than kg/m 2. These can be used if standard or alternative measurements cannot be obtained. Subjective criteria should be used together to aid the professional s judgement of the individual s overall malnutrition risk category (low, medium or high). These can be used if standard or alternative measurements cannot be obtained. 1. BMI: If the patient is thin or has protruding bones, malnutrition is possible. If the patient is of acceptable weight or over weight, malnutrition is unlikely. 2. loss: the presence of the following are suggestive of some degree of : Loose clothing, jewellery (e.g. wedding band, wrist watch). 3-6 month history of decreased food intake/appetite or swallowing problems and/or underlying disease likely to cause. 3. Acute disease effect: malnutrition risk is possible if the patient is acutely ill and has had no nutritional intake for more than 5 days. The Malnutrition Universal Screening Tool ( MUST ) is adapted and reproduced here with the kind permission of BAPEN (British Association for Parenteral and Enteral Nutrition). For further information on MUST see www.bapen.org.uk 4

Step 2 loss score Start with person s CURRENT weight then read across to find where their PREVIOUS weight fits this weight gives the score. Current kg Previous kg (3-6 months ago) SCORE 0 Less than 5% SCORE 1 Between 5-10% SCORE 2 More than 10% kg less than.6.6 -.3 more than.3 kg less than.6.6 -.4 more than.4 kg less than.7.7 -.6 more than.6 kg less than.7.7 -.7 more than.7 kg less than.8.8 -.7 more than.8 kg less than.8.8 -.9 more than.9 kg less than.9.9 -.0 more than.0 kg less than.9.9 -.1 more than.1 kg less than.0.0-42.2 more than 42.2 kg less than.1.1-43.3 more than 43.3 kg less than 42.1 42.1-44.4 more than 44.4 kg less than 43.2 43.2-45.6 more than 45.6 42 kg less than 44.2 44.2-46.7 more than 46.7 43 kg less than 45.3 45.3-47.8 more than 47.8 44 kg less than 46.3 46.3-48.9 more than 48.9 45 kg less than 47.4 47.4-50.0 more than 50.0 46 kg less than 48.4 48.4-51.1 more than 51.1 47 kg less than 49.5 49.5-52.2 more than 52.2 48 kg less than 50.5 50.5-53.3 more than 53.3 49 kg less than 51.6 51.6-54.4 more than 54.4 50 kg less than 52.6 52.6-55.6 more than 55.6 51 kg less than 53.7 53.7-56.7 more than 56.7 52 kg less than 54.7 54.7-57.8 more than 57.8 53 kg less than 55.8 55.8-58.9 more than 58.9 54 kg less than 56.8 56.8-60.0 more than 60.0 55 kg less than 57.9 57.9-61.1 more than 61.1 56 kg less than 58.9 58.9-62.2 more than 62.2 57 kg less than 60.0 60.0-63.3 more than 63.3 58 kg less than 61.1 61.1-64.4 more than 64.4 59 kg less than 62.1 62.1-65.6 more than 65.6 60 kg less than 63.2 63.2-66.7 more than 66.7 61 kg less than 64.2 64.2-67.8 more than 67.8 62 kg less than 65.3 65.3-68.9 more than 68.9 63 kg less than 66.3 66.3-70.0 more than 70.0 64 kg less than 67.4 67.4-71.1 more than 71.1 65 kg less than 68.4 68.4-72.2 more than 72.2 66 kg less than 69.5 69.5-73.3 more than 73.3 67 kg less than 70.5 70.5-74.4 more than 74.4 68 kg less than 71.6 71.6-75.6 more than 75.6 69 kg less than 72.6 72.6-76.7 more than 76.7 70 kg less than 73.7 73.7-77.8 more than 77.8 71 kg less than 74.7 74.7-78.9 more than 78.9 72 kg less than 75.8 75.8-80.0 more than 80.0 73 kg less than 76.8 76.8-81.1 more than 81.1 74 kg less than 77.9 77.9-82.2 more than 82.2 75 kg less than 78.9 78.9-83.3 more than 83.3 76 kg less than 80.0 80.0-84.4 more than 84.4 Current kg Previous kg (3-6 months ago) SCORE 0 Less than 5% SCORE 1 Between 5-10% SCORE 2 More than 10% 77 kg less than 81.1 81.1-85.6 more than 85.6 78 kg less than 82.1 82.1-86.7 more than 86.7 79 kg less than 83.2 83.2-87.8 more than 87.8 80 kg less than 84.2 84.2-88.9 more than 88.9 81 kg less than 85.3 85.3-90.0 more than 90.0 82 kg less than 86.3 86.3-91.1 more than 91.1 83 kg less than 87.4 87.4-92.2 more than 92.2 84 kg less than 88.4 88.4-93.3 more than 93.3 85 kg less than 89.5 89.5-94.4 more than 94.4 86 kg less than 90.5 90.5-95.6 more than 95.6 87 kg less than 91.6 91.6-96.7 more than 96.7 88 kg less than 92.6 92.6-97.8 more than 97.8 89 kg less than 93.7 93.7-98.9 more than 98.9 90 kg less than 94.7 94.7-100.0 more than 100.0 91 kg less than 95.8 95.8-101.1 more than 101.1 92 kg less than 96.8 96.8-102.2 more than 102.2 93 kg less than 97.9 97.9-103.3 more than 103.3 94 kg less than 98.9 98.9-104.4 more than 104.4 95 kg less than 100.0 100.0-105.6 more than 105.6 96 kg less than 101.1 101.1-106.7 more than 106.7 97 kg less than 102.1 102.1-107.8 more than 107.8 98 kg less than 103.2 103.2-108.9 more than 108.9 99 kg less than 104.2 104.2-110.0 more than 110.0 100 kg less than 105.3 105.3-111.1 more than 111.1 101 kg less than 106.3 106.3-112.2 more than 112.2 102 kg less than 107.4 107.4-113.3 more than 113.3 103 kg less than 108.4 108.4-114.4 more than 114.4 104 kg less than 109.5 109.5-115.6 more than 115.6 105 kg less than 110.5 110.5-116.7 more than 116.7 106 kg less than 111.6 111.6-117.8 more than 117.8 107 kg less than 112.6 112.6-1.9 more than 1.9 108 kg less than 113.7 113.7-1.0 more than 1.0 109 kg less than 114.7 114.7-1.1 more than 1.1 110 kg less than 115.8 115.8-1.2 more than 1.2 111 kg less than 116.8 116.8-1.3 more than 1.3 112 kg less than 117.9 117.9-1.4 more than 1.4 113 kg less than 1.9 1.9-1.6 more than 1.6 114 kg less than 1.0 1.0-1.7 more than 1.7 115 kg less than 1.1 1.1-1.8 more than 1.8 116 kg less than 1.1 1.1-1.9 more than 1.9 117 kg less than 1.2 1.2-1.0 more than 1.0 1 kg less than 1.2 1.2-1.1 more than 1.1 1 kg less than 1.3 1.3-1.2 more than 1.2 1 kg less than 1.3 1.3-1.3 more than 1.3 1 kg less than 1.4 1.4-1.4 more than 1.4 1 kg less than 1.4 1.4-1.6 more than 1.6 1 kg less than 1.5 1.5-1.7 more than 1.7 Current kg Previous kg (3-6 months ago) SCORE 0 Less than 5% SCORE 1 Between 5-10% SCORE 2 More than 10% 1 kg less than 1.5 1.5-1.8 more than 1.8 1 kg less than 1.6 1.6-1.9 more than 1.9 1 kg less than 1.6 1.6-1.0 more than 1.0 1 kg less than 1.7 1.7-1.1 more than 1.1 1 kg less than 1.7 1.7-142.2 more than 142.2 1 kg less than 1.8 1.8-143.3 more than 143.3 1 kg less than 1.8 1.8-144.4 more than 144.4 1 kg less than 1.9 1.9-145.6 more than 145.6 1 kg less than 1.9 1.9-146.7 more than 146.7 1 kg less than 1.0 1.0-147.8 more than 147.8 1 kg less than 1.1 1.1-148.9 more than 148.9 1 kg less than 142.1 142.1-150.0 more than 150.0 1 kg less than 143.2 143.2-151.1 more than 151.1 1 kg less than 144.2 144.2-152.2 more than 152.2 1 kg less than 145.3 145.3-153.3 more than 153.3 1 kg less than 146.3 146.3-154.4 more than 154.4 1 kg less than 147.4 147.4-155.6 more than 155.6 1 kg less than 148.4 148.4-156.7 more than 156.7 142 kg less than 149.5 149.5-157.8 more than 157.8 143 kg less than 150.5 150.5-158.9 more than 158.9 144 kg less than 151.6 151.6-160.0 more than 160.0 145 kg less than 152.6 152.6-161.1 more than 161.1 146 kg less than 153.7 153.7-162.2 more than 162.2 147 kg less than 154.7 154.7-163.3 more than 163.3 148 kg less than 155.8 155.8-164.4 more than 164.4 149 kg less than 156.8 156.8-165.6 more than 165.6 150 kg less than 157.9 157.9-166.7 more than 166.7 151 kg less than 158.9 158.9-167.8 more than 167.8 152 kg less than 160.0 160.0-168.9 more than 168.9 153 kg less than 161.1 161.1-170.0 more than 170.0 154 kg less than 162.1 162.1-171.1 more than 171.1 155 kg less than 163.2 163.2-172.2 more than 172.2 156 kg less than 164.2 164.2-173.3 more than 173.3 157 kg less than 165.3 165.3-174.4 more than 174.4 158 kg less than 166.3 166.3-175.6 more than 175.6 159 kg less than 167.4 167.4-176.7 more than 176.7 160 kg less than 168.4 168.4-177.8 more than 177.8 161 kg less than 169.5 169.5-178.9 more than 178.9 162 kg less than 170.5 170.5-0.0 more than 0.0 163 kg less than 171.6 171.6-1.1 more than 1.1 164 kg less than 172.6 172.6-2.2 more than 2.2 165 kg less than 173.7 173.7-3.3 more than 3.3 166 kg less than 174.7 174.7-4.4 more than 4.4 167 kg less than 175.8 175.8-5.6 more than 5.6 168 kg less than 176.8 176.8-6.7 more than 6.7 169 kg less than 177.9 177.9-7.8 more than 7.8 170 kg less than 178.9 178.9-8.9 more than 8.9 5

Great Western Hospitals Food First Advice for Improving Nutrition NHS Foundation Trust Food First is an approach to treating poor dietary intake and unintentional using every day nourishing foods and drinks. Please see below for suggested ideas to help improve the nutritional intake of an individual with a small appetite. Food First advice for Improving Nutrition patient information booklet is available to print from GWH intranet (http://gwh-intranet). Small frequent meals and snacks Nourishing snacks or nourishing drinks between meals Recommend full fat or high energy options (if appropriate to medical conditions i.e. diabetes) Recommend the use of frozen or ready-made meals and snacks if food preparation is tiring Recommend food fortification to increase the nourishment from foods and drinks Ideas for Food Fortification Add butter to potatoes and vegetables Thickly spread butter on bread or toast Add grated cheese to mashed potato, soups, sauces and scrambled eggs Add sugar, honey or syrup to hot drinks, porridge, cereals and into puddings Add milk or cream to soups and sauces Use mayonnaise or dressing on salad or sandwiches Make hot drinks with fortified milk Nourishing Drink Ideas Hot or cold milky drink (0-450kcal) 0ml whole milk (full cream or full fat) 4 heaped tablespoons (tbsp) milk powder (or 2 heaped tbsp milk powder and 2 tbsp cream) 1-2 tbsp milkshake powder or syrup, instant coffee, hot chocolate or malted drink Nourishing instant soup (0kcal) 0ml whole milk 2 heaped tbsp milk powder 1 individual packet soup Created by Registered Dietitians The Nutrition and Dietetic Departments; (Salisbury District Hospital, Royal United Hospital, St Martins Hospital, Chippenham Hospital and The Great Western Hospital) www.gwh.nhs.uk Nourishing Snack Ideas Try eating one nourishing snack between each meal (mid-morning, mid-afternoon, before bed) Sweet options Milky puddings (rice pudding, custard, mousse) Whole milk yoghurts (full cream or full fat) Chocolate, biscuits, cakes, pastries Cereal or breakfast bars Dried fruit Tea cakes, scones, malt loaf, crumpets spread with butter and jam Breakfast cereal with fortified milk Savoury options Toast, crumpets, muffins, bread, bagel (with butter, cheese, ham, pate) Pork pie, sausage roll, scotch egg Cheese on toast, beans on toast Crisps, cheese and crackers Slice of pizza or quiche Nuts / Peanut butter How to make Fortified Milk Add 4-5 tablespoons of milk powder to 1 pint of whole milk Fortified milk can be used for milky drinks, milky puddings, porridge, cereal CS156 NHS Creative January 14 6