Malnutrition can happen when your body does not get enough nutrients from your diet. It can also happen when you have a low body weight or have recently lost a lot of weight.

It is quite common in people with a kidney condition. 

When your kidneys are not working well, this can mean that you lose your appetite and feel nauseated. It can also affect the way food tastes.

Malnutrition increases your risk of:

• Illness, infection, and slow recovery. 
• Slow wound healing. Muscle loss (including muscles like the heart and lungs). 
• Fatigue. 
• Falls. 
• Low mood. 
• Being unable to do your usual activities.

How can I prevent malnutrition?

• Aim to eat ‘little and often’. This means trying to eat smaller meals, snacks, and drinks every 2-3 hours. This can be helpful if you are not able to eat large portions. 
• Try not to skip a meal. If you cannot manage a main meal, have a nourishing snack or drink instead. 
• If your appetite is better at a certain time of the day, aim to eat more at that time. 
• Eat what you fancy when you feel you can. See the ideas later in this information.
• When you feel well, cook extra portions of meals and freeze them for use on another day. If it is a family member who usually cooks your meals, ask them to cook extra of the meals you like and freeze them. 
• Fortify your meals and snacks. Food fortification increases the number of calories and nutrients without increasing how much you are eating. How to do this is explained later. 
• You may find it easier to have some ready meals in the freezer. Companies such as Wiltshire Farm Foods and Oakhouse Foods deliver ready meals. There is also a choice of smaller portions. 
• Do not drink a lot of fluid just before your meal. This can fill you up and reduce your appetite. Try to choose nutritious drinks if you are going to have them. 
• A few minutes of fresh air can increase your appetite. A short walk outside can be helpful too.

All the tips above are explained in more detail below.

Nutrition goals

Remember to set yourself 1-2 realistic nutrition goals when thinking about what changes you could make to your current eating habits. You can write your nutrition goals down. Writing your goals down will help you to remember what you want to do. You can also share this with your family and health care team.

It can be challenging to eat well if your appetite is poor, and you are also trying to avoid certain foods for your kidneys. 

You may not need to limit foods that are high in phosphate, potassium, or salt for now. Your dietitian can give you more guidance. 

If you take phosphate binder tablets you should continue to take these as usual. 

If your eating pattern has changed then you can ask your dietitian for advice on fitting your binders to your food.

What is food fortification?

‘Fortifying’ is another word for enriching. It means adding extra energy and nutrients to food. This is particularly important if you can only manage to eat small amounts.

How can I fortify my meals and snacks? 

Here are some ways to increase the calories and nutrients in your food:

Fortify with butters and oils

• Choose full fat butters and spreads. 
• Add butter, spread or oil to rice, pasta, potatoes and vegetables. 
• Add butter, spread or oil when cooking such as frying or oven roasting.
• Add butter or spread to scrambled egg or omelette. 
• Put butter or spread thickly on bread or toast before adding jam, marmalade, or savoury topping.

Fortify with mayonnaise and salad cream

• se full fat mayonnaise and salad cream. 
• Add generous amounts of mayonnaise or salad cream to sandwich fillings such as tuna, egg or chicken mayonnaise. 
• Have mayonnaise and salad cream on salads, baked potatoes and with potato chips. 
• Have coleslaw and other mayonnaise or salad cream- based salads as a vegetable with your meal.

Fortify with sugar, honey, and syrup 

If you have diabetes, you may be used to reducing sugar. While you are not eating well you can relax this a bit. Discuss this further with your dietitian.

• Add sugar or honey to hot drinks.
• Add sugar, honey, or syrup to porridge and breakfast cereals.
• Sprinkle or drizzle over tinned or stewed fruit, rice pudding, custard, and puddings.

Fortify with milk, full fat plain yoghurt, cream, or cheese

• Use full fat milk, yoghurts, and cheese. You could use single or double cream. 
• Add milk, yoghurt or cream to soups, scrambled egg or omelette. 
• Add milk, cream and/or cheese to mashed potato. 
• Make cream-based sauces for pasta, fish, and vegetables, such as cauliflower cheese, baked fish and cheese sauce, pasta carbonara. You could add cheese to these sauces too. 
• Add yoghurt or cream to creamy curry sauces. Sprinkle grated hard cheese on top of meals, such as beans, egg or houmous on toast, spaghetti bolognese, soup and casseroles. 
• Include cream cheese or sliced hard cheese as an extra sandwich filling, for example having ham, beef or salmon with cheese.
• Drizzle cream over tinned and stewed fruit, desserts, or puddings.

It is important to choose drinks which contain calories and nutrients.

• Try not fill up on water, tea, or coffee, particularly before meals. 
• Make hot drinks, such as tea, chai, coffee, and hot chocolate with half or full fat milk. 
• Use sugar or honey instead of sweeteners in your hot drinks. 
• Choose full sugar squash instead of ‘no added sugar’ versions. 
• If you have been given nutritional supplement drinks, have these between meals.

You may be worried that eating more fat and sugar will affect your health. As malnutrition can cause other problems, it is important to tackle this first. Once you are eating well again you can go back to your normal healthy way of eating.

To include healthy fats in your diet, choose:

• live oil or rapeseed oil (monounsaturated fats). 
• Olive oil based full fat spreads. 
• Oily fish, such as mackerel, salmon, sardines, trout, fresh tuna. 
• Oily fruit and vegetables, such as *avocado or olives in oil. 
• *Nuts and seeds: pistachio, walnuts, chestnuts, almonds, hazelnuts, peanut, pecans and sunflower seeds

*check with your dietitian before eating lots of nuts or avocados as these are high in potassium.

Protein is important for keeping your muscles strong and healing wounds. 

Protein cannot be stored by the body. When you are unwell, the amount of protein your body needs can increase. 

It is important to have enough high protein foods every day. Try to have a high protein food at each of your meals every day.

Foods that are high in protein:

• All types of meat, chicken, turkey including cold meat and processed meats such as sausages, bacon and crumbed chicken. 
• All types of fish including processed fish such as those in breadcrumbs or batter and tinned fish. 
• Eggs.
•  Beans, lentils (including dhal) and chickpeas (including hummus). 
• Quorn, soya, tofu, and tempeh. 
• Any type of milk and cheese. 
• Yoghurts, fromage frais and kefir. Choose the higher protein ones.

Choose, where possible, fresh and unprocessed meat, fish, chicken, and turkey. These are lower in salt. Choose full fat and full sugar dairy and non-dairy foods.

There are no set rules, you don’t have to eat breakfast at breakfast or dinner at dinner time. You may find some of these ideas appeal at different times of the day.

Meal pattern

It can be helpful to stick a regular mealtime routine and not skip meals. However, this is not always necessary if you are still eating every few hours over the day and eating as much as you can and when you feel hungry.

Check with your healthcare team if you are on certain medication, such as insulin or glucose lowering medications. These may need to be taken at specific times of the day with food.

Make the most of ‘good days’.

If you cannot manage a meal, have a nutritious snack or drink instead. See some of the ideas given on this page.

Remember, not eating can make you feel like not eating.

Breakfast

• Thickly spread butter and jam on bread rolls, crumpets, muffins or croissants.
• Toast with nut butter.
• Danish pastries.
• French toast / eggy bread.
• Eggs – omelettes (fortified), scrambled (fortified), boiled or fried egg on buttered toast.
• Bacon or sausage sandwich.
• Baked beans topped with grated cheese on buttered toast.
• Small cooked breakfast with your choice of fried or scrambled (fortified) egg.
• Porridge made with full fat milk, cream and sugar, honey, or syrup.
• Cereal with full cream milk, cream, sugar or honey or syrup.
• Cheese and cold meat roll.

Light meals and lunches

• Cheese and biscuits generously spread with butter or full fat spread.
• Sandwich or bagel or bread roll or pitta spread generously with butter or full fat spread and filled with a high protein filling such as:
  • Beef and horseradish, ham and cheese, chicken and pesto, turkey, cheese and pickle, tuna mayonnaise, egg or chicken mayonnaise, hummus and falafel or nut butter.
• Try different types of bread, such as ciabatta, baguettes, and paninis.
• Baked beans topped with cheese on buttered toast.
• Eggs – omelettes (fortified), scrambled (fortified), boiled or fried egg on buttered toast.
• Bacon or sausage and fried egg sandwich.
• Soup, such as cream of chicken or lentil with buttered bread/toast.
• Sausage roll, scotch egg, pasty or pork pie.
• Pizza or quiche.
• Tinned spaghetti topped with grated cheese.

Main meals

• Plain fish topped with white or parsley or cheese sauce (made with full fat milk), mashed potato (fortified).
• Fish pie or cottage pie topped with fortified mashed potato and grated cheese.
• Macaroni cheese or lasagna or creamy pasta using fortified cheese sauce.
• Meat or vegetable bolognese topped with grated cheese.
• Lentil or vegetable pie topped with fortified mashed potato and grated cheese.
• Cheesy potato, cauliflower, or broccoli bake with extra cheese topping.
• Creamy (fortified) risottos with protein foods and extra cheese topping.
• Ready-made meals from a supermarket or home delivery company such as Wiltshire Farm Foods or Oakhouse Foods.

Snacks and puddings

• Rice pudding, custard, or yoghurt (not the low fat version).
• Trifle.
• Class of full cream milk and biscuits.
• Danish pastry, doughnut, jam tart, Swiss roll, or cream cake.
• Milk jelly.

Your dietitian may recommend also nutritional supplements alongside this advice. There are milk style and fruit juice style drinks, desserts, and powders. Samples can be provided for you to try. They can be prescribed for a few months by your GP.

If you already have nutritional supplements, try the following:

• Chill them before drinking.
• Use them instead of your usual milk on cereal.
• Add them to yoghurt or custard.

If you find them too thick or sweet you can dilute juice-based supplements with fizzy drinks and milky ones with milk. You could make them into a smoothie or milk shake, jellies, sorbets, slushies or ice cream. Ask your dietitian for some recipes.

Most supplements come in multiple flavours. Ask the pharmacist for a different flavour if you don’t like the one you are usually given.

• Eat food that appeals to the senses.
• If the smell of some foods affects you then try to:
  • Avoid the kitchen during cooking.
  • Avoid cooking things with strong smells (e.g. Brussel sprouts, fish).
• Choose cold foods.
• Choose foods that are quick to prepare.
• Make food more attractive by adding a garnish.
• If you’ve lost interest in eating, try to imagine foods with appealing sights and smells, then try a small portion.

If you are able, fresh air and a small amount of exercise before a meal can help increase your appetite. Make meals sociable and in a relaxed, pleasant environment.

A small amount of alcohol before a meal can increase your appetite (check with your doctor first as alcohol can interact with some medications).

Setting yourself a nutrition goal and writing it down will help you succeed. See the example below to help you plan your goal. 

Example

What do you want to do and when?

I want to start using full fat milk on Friday after I’ve been shopping.

Why do you want to do it?

To give me extra nourishment and stop me losing weight.

How will you do it?

Every day I will add full cream milk to tea and use on cereal .

Try to answer these questions yourself and write down your goal.