Acting on screening results: a guide to treating malnutrition in the community.

Part 1 of this article described the Malnutrition Universal Screening Tool (MUST) and its implementation. Part 2 aims to provide basic practical guidance for treating malnutrition. Establishing the aim of treatment and undertaking a dietary assessment will provide the basis for your intervention. Addressing nutrition-related problems, such as drug induced gastrointestinal disturbances, will improve the efficacy of your treatment. A food-first approach should be adopted, paying attention to meal pattern, snacks, appropriate food choices, and food fortification. Over-the-counter supplements can be useful. Proprietary (prescribable) nutritional supplements or sip feeds should be used if dietary intervention does not sufficiently improve nutritional status. Consideration of patient preferences regarding flavour, style and presentation are necessary for compliance and particular care is required when selecting sip-feeds for patients with diabetes. Regular monitoring is essential and gradual discontinuation of supplements should commence if the aim of treatment is achieved. Assistance from dietetic services should be sought in developing a locally agreed policy for treating malnutrition.