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GPs must screen for malnutrition

GPs are to be thrust further to the frontline of public health after new NICE guidance recommended practices screen all newly registered patients for malnutrition.

The guidance urges GPs to check all adults for signs of malnutrition at health checks and influenza injections, and to consider it where there is 'clinical concern', such as poor wound healing.

GPs are also advised to check for malnutrition in patients admitted to care homes.

NICE warned malnourished patients were often slipping under the radar in general practice, but GPs said practices could not take on sole responsibility for public health issues.

Professor Paul Little, RCGP representative on the guideline development group, warned between 5 and 10 per cent of elderly people in general practice would be malnourished.

Professor Little, professor of primary care research at the University of Southampton, said: 'GPs and others in primary care see the vast majority of patients who are malnourished, but may not think of malnutrition during clinical management.'

He added: 'To some extent it's screening but it's more about good clinical care. A lot of GPs might be measuring people but there will be some for whom weight-at-baseline isn't something they're doing.'

NICE said GPs should screen by measuring BMI, percentage unintentional weight loss, likelihood of future impaired nutrient intake and time over which nutrient intake had been unintentionally reduced.

It recommended using the Malnutrition Universal Screening Tool to assess those suffering from malnutrition or at risk of it, and to offer these patients nutrition support.

Dr Chaand Nagpaul, a former member of the BMA public health committee and a GP in Middlesex, criticised the implication that GPs were not managing malnutrition: 'To suggest that GPs somehow aren't involved in giving nutritional advice isn't correct.'

But he added: 'This is not all about GPs ­ there are wider issues around malnutrition. It would be simplistic to think this is something GPs alone are responsible for dealing with.'

Dr David Haslam, a GP in Hertfordshire whose practice offers patients discounts on red meat, said the guidance was useful but obesity was a more important priority.

NICE examples of clinical triggers for malnutrition testing

  • Unintentional weight loss
  • Fragile skin
  • Poor wound healing
  • Apathy
  • Wasted muscles
  • Poor appetite
  • Altered taste sensation
  • Impaired swallowing
  • Altered bowel habit
  • Loose-fitting clothes

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