The European Nutrition for Health Alliance



Optimal Nutritional Care for All Resources

Aim: To Create a platform for sharing existing good practice



Welcome to the Optimal Nutritional Care for All Resources. .

These pages aim to provide information and signposting for individuals and countries looking to develop nutritional policy by providing definitions, evidence and good practice examples.  These can be used to frame National Nutrition Policy, create a case for change and demonstrate the impact of good nutritional policy.

The Resources are a compilation of information from our research and our partner/member organisations (ESPEN, BAPEN, EUGMS, EFAD and patient organisations).  We have also included links to sites from other expert organisations (e.g. BAPEN) which have been approved by our members. We aim to review and update these pages on a six monthly basis and would welcome feedback and contributions from users.

We hope you will find the following information useful. We’d love to hear what you think.

Contact us here

Please note:  Whilst every attempt has been made to ensure these links are up to date, websites are constantly changing. ENHA takes no responsibility for the content of the links provided in the Resources. Note:  the term malnutrition is used to mean undernutrition.  Both these terms are used regularly in the literature in this way.


Definitions and glossary of terms

ENHA has produced a glossary of commonly used terms which can be accessed here

ENHA uses the following definition of malnutrition (undernutrition), which has been agreed by its members.

‘Malnutrition, defined as an imbalance of energy, protein, and other nutrients that causes measurable adverse effects on tissue and body form and function as well as clinical outcomes.  Malnutrition is most often used to mean undernutrition.’

Alternative definitions from useful sources


Malnutrition is a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein and other nutrients causes measurable adverse effects on tissue / body form (body shape, size and composition) and function and clinical outcome. The term malnutrition does include obesity, but in this context undernutrition is the focus.

NICE guidance (UK)

Malnutrition is a state in which a deficiency of nutrients such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical outcome.  Malnutrition is both a cause and a consequence of ill health.  It is common and increases a patient's vulnerability to disease

A consensus statement from ESPEN on the diagnostic criteria for malnutrition is currently in press (Clinical Nutrition).

Building the Case for Change

Cost of malnutrition

ENHA have produced a simple first stage ‘costing analysis’.  This provides a template for a basic calculation of the approximate costs that can be attributed to increased length of hospital stay resulting from malnutrition.  It can be applied on a national level and may provide a starting point for further analysis.

Access the costing calculation

Access the references/bibliography

Financial benefits of screening/nutritional intervention

Access the references/bibliography

Policy documents

Access the references/bibliography

Key Performance Indicators

Defining and explaining KPIs

National websites showcasing nutrition policies/plans

NetherlandsFight Malnutrition (Dutch Malnutrition Steering Group)

UKMalnutrition Task Force

Ireland Call to Action Dec 2013

Spain - A nutrition alliance of stakeholders (nutridos alliance) who are a part of Spain’s ONCA project


Stakeholder groups with an interest in nutrition

European Patients Forum


European Hydration Institute


ENHA believes that systematic, routine screening of at risk groups is key in preventing malnutrition, particularly among older people.

Validated Screening Tools

ESPEN recognises the tools below for use in screening.

Mini Nutritional Assessment: Short Form (MNA-SF)

Nutrition Risk Screening

Malnutrition Universal Screening Tool (MUST)

MUST is also available in French, German, Italian, Portuguese and Spanish



For nutrition standards, position papers for professional and standards of care.

ESPEN Guidelines 

EFAD – European Federation of the Associations of Dietitians - Position paper on the Role of the Dietitian in the Prevention and Management of Malnutrition in Adults  

UK – National Institute of Health and Clinical Excellence – Guidance on Nutrition Support

UK – National Association of Care Caterers/Hospital Caterers Association - 10 key characteristics for good nutritional care


Care Pathways

Managing Adult Malnutrition in the Community – UK


Education and Training

Training for geriatricians

EUGMS – European Union Geriatric Medicine Society

Developed to educate physicians and other health care providers on all nutritional aspects in the care of older people.


ESPEN - European Society for Clinical Nutrition and Metabolism

ESPEN Life Long Learning (LLL) Programme in Clinical Nutrition and Metabolism

Based on an Educational curriculum offering 120 training modules (100 are already available on-line) created and peer reviewed by recognized European experts. Accredited by Union Européenne des Médecins Spécialistes.  Aimed at Medical Doctors and Health Specialists, modules are freely accessible on-line after registration


Training for nurses and care staff

BAPEN – British Association for Parenteral and Enteral Nutrition

BAPEN e-learning modules for Doctors in training

Three modules available:

  • Disease related malnutrition
  • Nutrition support – methods and monitoring
  • Nutrition support – ethical and legal issues

MUST training from BAPEN

Available for those working in hospitals, care homes and primary care.


Prevention, public awareness

UK - National Association of Care Caterers in association with Hospital Caterers Association & NHS England- Nutrition and Hydration week

UK – Guardian Newspaper – In focus – How do we tackle Malnutrition in the UK?


References/Bibliography ()

ONCA Resources - Glossary of terms ()

Calculating Costs Associated with Extended Hospital Stay due to Malnutrition ()

Key Performance Indicators (KPIs) ()

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