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Manage malnutrition

To manage malnutrition start with 1 pint of fortified milk, 2 nourishing snacks and 3 fortified 2-course meals.
For care home residents at risk of malnutrition (MUST score of 1 or more), offering the below daily can help in reducing malnutrition risk.

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)
  • 50-60g/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/whisk well.

Calories: 540 kcal
Protein: 37g

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 savoury and sweet snacks should be given, 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
Protein: 20g

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

Manage malnutrition with homemade fortified drinks

Alongside using the 1 2 3 approach, consider offering 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 giving them between meals and consider giving in smaller ‘shots’ over the day if preferred.

Fortified milkshake

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/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 and marshmallows to finish, 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.

Training for care homes

Our care home support dietitians, are providing free training and resources to support care homes across Cornwall and the Isles of Scilly in identifying and treating malnutrition risk. For more information, email our care home medicines team.

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