When should I consider referring a patient with malnutrition to a dietitian or specialist service?

Consider referring a patient with malnutrition to a dietitian or specialist service when:

• They are identified as malnourished, defined by a BMI less than 18.5 kg/m², unintentional weight loss greater than 10% within the last 3 to 6 months, or a BMI less than 20 kg/m² with unintentional weight loss greater than 5% within the last 3 to 6 months.
• They are at risk of malnutrition, for example, if they have eaten little or nothing for more than 5 days or are likely to do so, have poor absorptive capacity, high nutrient losses, or increased nutritional needs due to catabolism.
• There are clinical concerns such as unintentional weight loss, poor wound healing, apathy, muscle wasting, poor appetite, altered taste sensation, impaired swallowing, or prolonged intercurrent illness.
• In children, if there is concern about faltering growth or weight loss, referral to a paediatric dietitian or specialist service is advised.
• When an eating disorder is suspected, immediate referral to an age-appropriate eating disorder service is recommended.

Referral ensures coordinated multidisciplinary care and access to specialist nutritional assessment and management, including oral, enteral, or parenteral nutrition support as appropriate.

References: NICE CG32, NICE NG75, NICE NG69