Are you at risk of poor nutrition?
Have you been losing weight without meaning to? Or have you noticed that your clothing or jewellery are looser? If you, or someone you care for, are eating less than usual, you may be at risk of malnutrition. This could be due to a reduced appetite, being unwell, or not being able to go food shopping or prepare meals.
Malnutrition makes it more difficult for the body to fight illness and infection. It can make us feel weak, tired, and low in mood. To treat malnutrition, we need to increase the energy (calories), protein and other nutrients that we eat and drink.
We recommend that people who are at risk of malnutrition try to increase their nutritional intake by having regular snacks, nourishing drinks, and fortifying their food. The following leaflets give tips and advice on how to do this:
- food first advice for adults with a small appetite and diabetes: this leaflet is suitable if you have diabetes and are at risk of malnutrition
- managing malnutrition at home: simple recipes and a 1,2,3 approach to increasing your intake of energy, protein, and other nutrients
Nourishing and fortified drinks
Nourishing drinks can be useful to increase nutrition if you are eating small amounts. It is important to drink enough fluid (8 to 10 cups or glasses a day). Having drinks with additional nutrition such as milky drinks, milkshakes, soups, fruit juice, smoothies, hot chocolate and malted milk drinks can also help increase nutritional intake.
Our homemade fortified drinks leaflet (PDF, 558 KB) has recipes for drinks and desserts to help increase your energy and protein intake.
You can buy a range of fortified drinks from supermarkets and pharmacies (such as Complan, Meritene and Aymes Retail). View the full range of fortified drinks available (PDF, 67 KB).
You can check your malnutrition risk at home using self-screening tools. They can be a useful starting point. However, please ensure you seek advice from a healthcare professional if you are identified as at risk of malnutrition:
If you are concerned about nutrition, if you have been eating less, been unwell or have noticed unintentional weight loss, please contact your GP or healthcare professional for further advice.
As well as good nutrition it is important to ensure you drink enough fluid to stay hydrated.
Dehydration can increase the risk of falls, infections such as urinary tract infections, constipation and cause confusion and tiredness.
Aim to drink 8 to 10 cups or glasses of fluid every day (1,600 ml to 2,000 ml). This may need be increased in hot weather, if you are exercising more, and if you are unwell with a high temperature.
Water, milk, juices, squash, tea, and coffee all count. If you are struggling to eat, enough consider nourishing drinks such as milky drinks, milkshakes, soups, fruit juice, smoothies, hot chocolate and malted milk drinks.
The BDA fluid and food information sheet (PDF, 586 KB) is full of facts about why you should stay hydrated.
Managing malnutrition at home
This section is aimed at people managing malnutrition at home or those who care for people in their own homes. It explains how to use the 1,2,3 approach. It is aimed at adults only and is not suitable for children.
You may have a poor appetite or have been eating less due to feeling unwell. If you are not getting enough nutrition to meet your body’s needs you will lose weight and could be at risk of malnutrition.
Malnutrition makes it more difficult for the body to fight illness and infection and can make us feel weak, tired and low in mood. To treat malnutrition we need to increase the energy (calories) and protein that we eat and drink.
Trying to include the 1,2,3 below can help increase your intake of energy (calories), protein and other nutrients. Email our prescribing team for information on managing malnutrition at home.
1 pint of fortified milk
Use fortified milk in place of normal milk throughout the day as a simple way of boosting nutritional intake without increasing volume. It can be used in hot and cold drinks, cereals, egg dishes, baking, sauces, soups and milk puddings.
- 1 pint whole milk (blue top)
- 50 to 60g or 4 heaped tablespoons dried skimmed milk powder
- Add skimmed milk powder to jug.
- Add a small amount of whole milk and mix to form a smooth paste.
- Gradually add remaining milk and stir or whisk well.
Calories: 540 kcal
2 nourishing snacks
Nourishing snacks provide vital additional nutrition to those at risk of malnutrition and should be offered 2 to 3 times a day. A variety of sweet and savoury snacks is ideal, including a high calorie fortified snack. Below is our top recommended high calorie fortified snack.
Fortified thick and creamy yoghurt
- 1 heaped tablespoon (~15g) dried skimmed milk powder
- 1 tablespoon double cream
- 150g thick and creamy yoghurt
To make, mix the dried skimmed milk powder and double cream with the thick and creamy yoghurt.
Calories: 300 kcal
3 fortified 2-course meals
Large portions of food can be overwhelming for those with a small appetite; small regular meals with added fortification are often better received. How to fortify some common foods:
|If you have||Fortify by adding|
|Cereal or porridge||Fortified milk*, cream, full-fat or Greek yoghurt*, honey, syrup, jam, sugar, dried fruit, ground nuts*|
|Scrambled eggs||Butter, fortified milk*, grated cheese*|
|Soups and stews||Grated cheese*, cream, dumplings or croutons|
|Mashed potato||Butter, olive oil, fortified milk*, grated cheese*, skimmed milk powder* or double cream|
|Cooked vegetables||Grated cheese* or creamy sauces, olive oil, butter, mayonnaise or salad cream|
|Salads||Grated cheese*, olive oil or salad dressing, mayonnaise or salad cream|
|Custard and milky puddings||Skimmed milk powder*, double cream, condensed milk*, honey, syrup, sugar, jam or dried fruit|
- high protein option
Managing malnutrition at home with homemade fortified drinks
Alongside using the 1 2 3 approach, consider having 1 to 2 homemade fortified drinks a day. These can help in providing extra energy, protein and other nutrients. The following recipes provide similar calories and protein to many oral nutritional supplements. Try having them between meals and consider having in smaller ‘shots’ over the day if preferred.
Mix 2 heaped tablespoons of skimmed milk powder with 4 teaspoons of milkshake powder with added vitamins and minerals (Nesquik or Asda, Lidl and Morrisons alternative). Add 200mls of full-fat milk and 15mls double cream and stir well and blend.
Fortified hot chocolate
Mix 2 heaped tablespoons of skimmed milk powder with 200mls full fat milk and heat until warm. Add 4 teaspoons of hot chocolate powder with added vitamins and minerals (for example Nesquik hot chocolate powder) and stir well. Add 15ml double cream or marshmallows, as desired.
Fortified fruit juice
Mix 40ml high juice cordial with 10g egg white powder, and then gradually add 180ml fruit juice (with added vitamins). Do not whisk.
Page last reviewed: 12 July 2022