MAG New Guidance for COVID-19

The Malnutrition Action Group (MAG) has issued practical guidance for using the Malnutrition Universal Screening Tool (MUST) during the COVID-19 pandemic. During this time malnutrition has become a common problem due to the physiological effect of infection, restricted access to care, support, and shops, as well as limited ability to exercise and socialise.

To limit the spread of COVID-19, most assessments for malnutrition have been held virtually, making it difficult to use physical measurements as part of the assessment. MAG suggests asking the patient to report values of their current weight and height and then compare these to previous measurements to calculate BMI and weight loss. In cases where self-reported measurements cannot be accurately provided, subjective measures may be used. The patient’s psycho-social/physical disability and any underlying health conditions must be considered when assessing the likelihood of unplanned weight loss.

If a patient has become acutely ill with COVID and is likely to have or has had significantly reduced intake for more than five days, subjective criteria should be used to identify the risk of malnutrition (in line with local policy).

The consequences of COVID-related malnutrition can include:

  • Impaired immune function
  • Reduced respiratory and skeletal muscle strength
  • Effects on psychological function
  • Impaired recovery
  • Longer hospital stay


Additionally complete the referral form and send to for the Nutrition and Dietetics team from Hertfordshire Community NHS Trust.

  • EN Herts- Referral via your GP for the Hertfordshire Community NHS Trust Nutrition and Dietetics Team.



Undernutrition remains a concern for the older population in Hertfordshire, and isolation as a result of the current COVID-19 crisis is likely to increase this issue. Local guidance which may be useful, both to help prevent undernutrition at this time and to support older adults recovering from Covid 19, includes:

  • Food First – Eating well for small appetites focuses on enabling patients to increase their nutritional intake by at least 500 calories per day (in addition to other essential nutrients) and can be given out by any healthcare professional without additional explanation
  • Food First – Quick guide is a short version of the above leaflet and shows how an additional 500 calories (in addition to other essential nutrients) can be consumed simply by making 3 or 4 small dietary changes each day
  • Food First – Homemade supplements can be provided together with either of the above resources and is equally suitable for patients living in their own homes or in care homes. The homemade milkshake recipe is nutritionally almost identical to prescribed ONS
  • Eating and drinking at end of life is designed for relatives and carers of people who are reaching the end of their lives. It has been written to help reassure carers that loss of appetite and reduction in food intake is a normal and expected part of the dying process, and that prescribed ONS are unlikely to be helpful at this stage

British Dietetic Association (BDA) resources on nutrition, older people and self isolation during COVID-19

Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition

This guideline covers identifying and caring for adults who are malnourished or at risk of malnutrition in hospital or in their own home or a care home. It offers advice on how oral, enteral tube feeding and parenteral nutrition support should be started, administered and stopped. It aims to support healthcare professionals identify malnourished people and help them to choose the most appropriate form of support.


Pathway resources

Nutrition Support in Adult Pathway
Care Home Managing Malnutrition pathway

Natasha’s Law on care homes

This useful article from our partner apetito, reminds care homes of the importance of managing food allergies.

Read the article here

Nutrition support for adults with long COVID – 16th June 2021

The webinar aims to give insight on how to use practical tools for supporting adults in the community on managing their nutrition alongside the symptoms of long COVID. In addition, it provides an understanding of the challenges seen in long COVID and ways in which nutritional support can aid recovery.

This is specifically focused on those in the community that live in residential care or their own homes.


  • Simone Roberts, HLS
  • Sonia Shangari, EN Herts CCG


» Main slides | Click here
» Main recording | Click here

Nutrition and Dementia

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2020 improving the provision of nutritional care for people with dementia in care homes
Nutrition and Dementia guide for staff
Family, friends guide

Other resources

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Helping older adults keep well
Burwood Nursing Home – A guide to nutrition for the elderly
The eat well guide
Prescription Request Form

Nutrition and Learning Disabilities

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Social care staff briefing on the Mental Capacity Act in learning disabilities 
Social care staff supporting diet and exercise in learning disabilities


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