Oasis

⌕

Oasis
Precision Nutrition. Clinical Excellence.

Data-Driven. Evidence-Based.

0

Calculations

0

Saved Records

11

Modules

Recent Activity

Clinical Tools

NFPE

Physical exam · 11 domains

Meal Planner

Oral · ONS · Diet plans

24hr Recall

Dietary intake assessment

Recipe Tools

Recipe Calculator

Yield · Scaling · Weight change · Nutrition

NEW

Assessment Tools

SGA · MNA · PG-SGA · more coming

3 LIVE

Oasis AI

PES · ADIME · Assessment · Chat

BETA

Information

Food Database

Malawi FCT + local foods

History

Saved patient records

Reference

ASPEN · ESPEN · WHO guidelines

From the Developer

Hey everyone 👋 I built Oasis because clinical nutrition work had somehow become 50% manual calculations, 40% guideline hunting, and 10% actual patient intervention 😭 — and honestly, some of those nutrition references look like they were scanned using a microwave. Finding nutrient values for Malawian foods sometimes felt more like historical research than healthcare. 🇲🇼 So I put everything into one place: calculations, screening tools, PES generation, growth charts, AI assistance, guideline support, barcode scanning, and a local food database. The goal is simple — less time fighting PDFs, more time actually helping patients. Still improving it daily, so if you find a bug, get a weird result, or accidentally calculate 4,000 kcal for a toddler… please let me know 💀 Thanks for using Oasis. 🚀

Recipe Calculator

Yield · Scaling · Weight change · Nutrition

1 RECIPE DETAILS

RECIPE NAME

SERVINGS

SCALE FACTOR (×)

Multiply all amounts by this factor

2 INGREDIENTS

LIVE RECIPE TOTALS

—

ENERGY

—

PROTEIN

—

CARBS

—

FAT

—

TOTAL MASS

3 WEIGHT CALCULATION

INITIAL WEIGHT (g)

FINAL WEIGHT (g)

WEIGHT CHANGE %

—

((Final − Initial) ÷ Initial) × 100

Validated clinical nutrition assessment instruments. Select a tool to open the full form. Assessments run locally — no patient data is transmitted.

SGA

Subjective Global Assessment

Clinician-rated nutrition status · Weight · Symptoms · Physical exam

LIVE Open →

MNA

Mini Nutritional Assessment (Full)

18-item validated tool for geriatric populations (≥65 years)

LIVE Open →

PG-SGA

Patient-Generated SGA

Oncology-specific scored nutrition assessment · Patient + clinician rated

LIVE Open →

RECENT: No recent activity yet

Patient

Patient ID / Name

Age *

yrs

Sex *

♂ MALE

♀ FEMALE

Condition / Diagnosis *

Ward / Unit

Anthropometrics

▼

Height *

cm

Actual Weight *

kg

Admit Weight

kg

Usual Body Wt (UBW)

kg

EDW / Dry Weight

kg

MUAC (adult)

cm

Waist Circumference

cm

Oedema Grade

Lab Values

AMPATH Reference Ranges

▼

Full Blood Count (FBC)

Haemoglobin (Hb) M 13–17 · F 12–15 g/dL

g/dL

WBC 4.0–11.0 ×10⁹/L

×10⁹/L

Platelets 150–400 ×10⁹/L

×10⁹/L

MCV 80–100 fL

fL

Neutrophils 2.0–7.5 ×10⁹/L

×10⁹/L

CRP <5 mg/L

mg/L

Electrolytes & Refeeding Markers

Potassium (K⁺) 3.5–5.0 mmol/L

mmol/L

Phosphate (PO₄) 0.75–1.50 mmol/L

mmol/L

Magnesium (Mg²⁺) 0.70–1.05 mmol/L

mmol/L

Sodium (Na⁺) 136–145 mmol/L

mmol/L

Calcium (Ca²⁺ total) 2.15–2.55 mmol/L

mmol/L

Chloride (Cl⁻) 98–106 mmol/L

mmol/L

Liver Function Tests (LFT)

ALT 7–56 U/L

U/L

AST 10–40 U/L

U/L

ALP 44–147 U/L

U/L

Total Bilirubin 3–21 µmol/L

µmol/L

Albumin 35–52 g/L

g/L

INR 0.8–1.2

ratio

Renal Function Tests (RFT)

Creatinine 60–120 µmol/L

µmol/L

Urea 2.5–7.5 mmol/L

mmol/L

eGFR >60 mL/min

mL/min

Uric Acid M 202–416 µmol/L

µmol/L

Nutritional Biomarkers

Pre-albumin 0.20–0.40 g/L

g/L

Transferrin 2.0–3.6 g/L

g/L

HbA1c <5.7%

%

Glucose 3.9–6.1 mmol/L

mmol/L

Metabolic / Lipids

Triglycerides <1.7 mmol/L

mmol/L

Cholesterol <5.2 mmol/L

mmol/L

GLIM 2019 — Malnutrition Assessment

NOT ASSESSED

▼

GLIM 2019 — Diagnosis requires ≥1 phenotypic criterion + ≥1 etiologic criterion. BMI and weight loss % are auto-calculated from anthropometrics above. Tick additional criteria as clinically assessed.

PHENOTYPIC CRITERIA — meet ≥1 for malnutrition diagnosis:

Reduced muscle mass — mild/moderate deficit (BIA / DEXA / anthropometry below validated cut-offs) Reduced muscle mass — severe deficit (validated tool)

Weight Loss Timeframe

Enter Usual Body Weight above to auto-calculate weight loss %

ETIOLOGIC CRITERIA — meet ≥1 for malnutrition diagnosis:

Reduced food intake / assimilation (≤50% EER >1 wk; or any reduction >2 wk; or GI malabsorption) Auto-synced Acute disease / injury (ICU admission, major surgery, trauma, severe infection) Chronic disease / inflammation (cancer, CKD, COPD, CVD, liver disease, HIV)

CLINICAL NUTRITION NOTE

A

Assessment

Patient data · Anthropometrics · Nutrition status · Laboratory findings

Anthropometrics

Actual BW

—

kg

Ideal BW

—

kg (Devine)

Adjusted BW

—

kg

BMI

—

kg/m²

Weight Used

—

D

Diagnosis

Nutrition diagnosis · PES statement · IDNT 2006

PES STATEMENTS & CLINICAL NUTRITION INSIGHTS

NUTRITION DIAGNOSIS — PES STATEMENTS

CLINICAL NUTRITION INSIGHTS

I

Intervention

Nutrition targets · Feeding route · Macro distribution · Micronutrients

Action

ND – Food/Nutrient Delivery

E – Nutrition Education

C – Nutrition Counseling

RC – Coordination of Care

Intervention Plan

Total Energy Target

—

kcal / day

Net Feeding Energy

—

kcal / day

After propofol / IV kcal

Protein Target

—

g / day

Protein per kg

—

g / kg / day

Fluid Requirement

—

mL / day

25–30 mL/kg/day

Propofol Calories

—

kcal / day

PROTEIN — GUIDELINE & CLINICAL RELEVANCE

FEEDING RECOMMENDATIONS

MACRONUTRIENT DISTRIBUTION DIAGNOSIS-SPECIFIC

Ranges are diagnosis-specific — adjust within bounds based on tolerance, labs, and clinical response.

24-Hour Dietary Recall

Malawi FCT (MoH) · Commercial Formulae · Household Measures · Full dietary analysis vs requirements

PATIENT REQUIREMENTS

Enter targets below or sync from Calculator tab

WEIGHT (kg)

ENERGY (kcal)

CARBOHYDRATE (g)

PROTEIN (g)

FAT (g)

FLUID (mL)

Enter weight (kg) to auto-estimate kcal (25 kcal/kg), CHO (3 g/kg), protein (1.2 g/kg), fat (0.8 g/kg), fluid (35 mL/kg) — or type targets directly — or sync from Calculator.

DAILY TOTALS vs REQUIREMENTS

0

kcal/day

— % of target

0

g CHO

— % of target

0

g Protein

— % of target

0

g Fat

— % of target

0

kJ/day

—

MACRONUTRIENT DISTRIBUTION

EXCHANGE SUMMARY

Meal Planner — Oral / ONS

Requirements auto-sourced from Calculator · UCT Exchange Lists + Malawi FCT + Therapeutic Foods

PATIENT REQUIREMENTS — SYNCED OR MANUAL

Sync from Calculator or enter manually

ENERGY (kcal)

CHO (g)

PROTEIN (g)

FAT (g)

FLUID (mL)

SELECT PLANNING MODE

AUTOMATIC MEAL PLAN GENERATOR

Malawi context · Oral, Enteral & Mixed modes · Works offline · Populates meal plan below

PATIENT INFO

Not synced

Run Adult or Pediatric calculator first, then tap Sync — or use Override to enter manually.

✎ MANUAL MEAL BUILDER BUTTON ▼

Search the food database → pick a portion → assign to a meal slot → macros tracked in real time below

Add Food Items — Malawi / Southern Africa Foods + ONS

Food Category i

Food Item

Description / Label

Portion / Household Measure

Servings

Meal

USDA FDC 🌐 Search USDA FoodData Central — food not in local database?

▼

Daily Nutrition Summary vs Targets

0

kcal/day

—

0

g CHO

—

0

g Protein

—

0

g Fat

—

0

kJ/day

MACRONUTRIENT DISTRIBUTION

Enteral Feeding Calculator

12-Step Edge Clinical Method · Requirements auto-sourced from Calculator · Fresenius Kabi Formula Database

REQUIREMENTS — SYNCED OR ENTER MANUALLY

Sync from Calculator or enter manually

ENERGY NET (kcal)

PROTEIN (g)

FLUID (mL)

NON-NUTR KCAL

STEP 1

Safety Check — Is Enteral Feeding Appropriate?

Confirm before proceeding:

Functional gut (bowel sounds present / gut accessible) Low or no vasopressors (MAP ≥65 mmHg, stable) Feeding tube confirmed in correct position No absolute contraindication (obstruction, ischaemia)

Refeeding Syndrome Risk

No / Low Risk

Yes — Refeeding Protocol

Kcal from Medications (Propofol, IV dextrose)

kcal/d

STEPS 2–4

Formula Selection & Mode of Delivery

Formula

Mode of Delivery

Hours of EN per Day

hrs

Low-Resource Hospital Formula

Malawi Standard Practice · Milk + Likuni Phala · Real-time nutrition calculation · Works offline

MALAWI CONTEXT

Sync or enter weight manually below

CLINICAL WARNINGS — READ BEFORE USE

• Not suitable for critically ill or haemodynamically unstable patients
• Not for patients with severe GI dysfunction, obstruction or ischaemia
• Monitor tolerance: nausea, vomiting, diarrhoea, abdominal distension — assess clinically before each feed
• Adjust recipe for renal/hepatic patients (reduce protein sources if indicated)
• Consult dietitian when available for individualised prescriptions

QUICK PRESETS — CLICK TO LOAD RECIPE

RECIPE BUILDER — ADJUST AMOUNTS PER BATCH

MILK (full cream) — ml

LIKUNI PHALA (cooked, sieved) — ml

VEGETABLE OIL — ml

SUGAR — g (optional)

TOTAL BATCH VOLUME — ml

Top up with clean boiled water to this volume

PATIENT REQUIREMENTS

Enter values below or sync from a calculator above

BODY WEIGHT (kg)
for per-kg calculations

ENERGY (kcal/day)
net kcal/day

PROTEIN (g/day)
g/day

FLUID (mL/day)
mL/day

NON-NUTR KCAL
propofol, IV glucose

FEEDING ROUTE

FEEDING METHOD

⏱ HANG TIME

2 h

ROOM TEMP

24 h

FRIDGE 4°C

1–2 h

AFTER REWARM

DISCARD

ALL LEFTOVERS

Blenderized Tube Feed

Build from local Malawian foods · Real-time nutrition · Presets included · Works offline

MALAWI FOODS

Sync or enter weight manually below

CLINICAL WARNINGS — READ BEFORE USE

• Not suitable for critically ill or haemodynamically unstable patients
• Must use large-bore tube (≥14 Fr) — blenderized feeds WILL block fine-bore tubes
• All foods must be thoroughly cooked and completely smooth-blended
• Monitor tolerance closely: start at 50% rate for first 12–24 hours
• Nutritional values are estimates — use as a guide, not an exact calculation

PRESET RECIPES — CLICK TO LOAD

ADD INGREDIENT

FOOD ITEM

AMOUNT (ml / g / units)

INGREDIENT LIST

TOTAL BATCH VOLUME (ml)

Food Item	Amount	kcal	Pro g	Fat g	CHO g
No ingredients yet — add from the selector above or load a preset.
TOTAL (raw batch)		—	—	—	—

PATIENT REQUIREMENTS

Enter values below or sync from a calculator above

BODY WEIGHT (kg)
for per-kg calculations

ENERGY (kcal/day)
net kcal/day

PROTEIN (g/day)
g/day

FLUID (mL/day)
mL/day

NON-NUTR KCAL
propofol, IV glucose

FEEDING ROUTE

FEEDING METHOD

TUBE & PREP

• ≥14 Fr tube — blenderized blocks fine-bore tubes
• Blend completely smooth · sieve if needed
• Flush 50 ml boiled water pre/post feed
• Wash hands · sterilised blender & utensils
• Fully cook ALL ingredients before blending
• Cool to body temp · label with prep time

⏱ HANG TIME

2 h

ROOM TEMP

24 h

FRIDGE 4°C

1–2 h

AFTER REWARM

DISCARD

ALL LEFTOVERS

Saved Calculations

No saved calculations yet.
Run a calculation and press Save.

NUTRITION GUIDELINE SOURCES

Key References

The clinical decision rules, energy targets, protein targets, and condition-specific thresholds used throughout Oasis are derived from the following peer-reviewed guidelines and consensus statements.

ICU & CRITICAL CARE

· McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: SCCM and ASPEN. JPEN J Parenter Enteral Nutr. 2016;40(2):159–211. — ASPEN/SCCM 2016 Critical Care Nutrition Guidelines [Current foundational guideline] · DOI: 10.1177/0148607115621863

· Compher C, Bingham AL, McCall M, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: ASPEN. JPEN J Parenter Enteral Nutr. 2022;46(1):12–41. — ASPEN 2022 Adult Critical Care Guidelines [Current standard] · DOI: 10.1002/jpen.2267

· Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the ICU. Clin Nutr. 2019;38(1):48–79. — ESPEN 2019 ICU Nutrition Guidelines · DOI: 10.1016/j.clnu.2018.08.037

· Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline: clinical nutrition in the intensive care unit. Clin Nutr. 2023;42(9):1671–1689. — ESPEN 2023 ICU Guidelines [Current standard] · DOI: 10.1016/j.clnu.2023.06.021

RENAL

· KDIGO. Clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(4):337–414. — KDIGO 2012 AKI Guidelines · DOI: 10.1038/kisup.2011.32

HEPATIC

· Plauth M, et al. Clin Nutr. 2019;38(2):485–521. — ESPEN 2019 Clinical Nutrition in Liver Disease

REFEEDING SYNDROME

· da Silva JSV, Seres DS, Sabino K, et al. ASPEN consensus recommendations for refeeding syndrome. Nutr Clin Pract. 2020;35(2):178–195. — ASPEN 2020 Consensus Recommendations [Current standard] · DOI: 10.1002/ncp.10474

· National Institute for Health and Care Excellence (NICE). Clinical Guideline CG32: Nutrition Support for Adults. London: NICE; 2006 (updated 2017). — NICE CG32 Nutrition Support for Adults · nice.org.uk/guidance/cg32

PANCREATITIS

· Arvanitakis M, Ockenga J, Becker T, et al. ESPEN guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr. 2020;39(3):612–631. — ESPEN 2020 Pancreatitis [Current standard] · DOI: 10.1016/j.clnu.2020.03.002

BURNS

· Rousseau A-F, Losser MR, Ichai C, et al. ESPEN endorsed recommendations: nutritional therapy in major burns. Clin Nutr. 2013;32(4):497–502. — ESPEN Burns 2013 [Current evidence-based guideline] · DOI: 10.1016/j.clnu.2013.02.012

· Prelack K, Dylewski M, Sheridan RL. Practical guidelines for nutritional management of burn injury and recovery. J Burn Care Res. 2007;28(1):377–396. — Pediatric burns — metabolic basis for Galveston / Curreri Jr. equations · DOI: 10.1097/BCR.0b013e318031a3b1

MALNUTRITION & DIAGNOSIS

· Cederholm T, Jensen GL, Correia MITD, et al. GLIM criteria for the diagnosis of malnutrition — a consensus report from the global clinical nutrition community. JPEN J Parenter Enteral Nutr. 2019;43(1):32–40. — GLIM 2019 [Global diagnostic consensus framework] · DOI: 10.1002/jpen.1440

CARDIAC

· McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–3726. — ESC 2021 Heart Failure [Current standard guideline] · DOI: 10.1093/eurheartj/ehab368

HIV / AIDS

· WHO. Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach. Geneva: WHO; 2021. ISBN 978-92-4-003159-3. — WHO HIV Consolidated 2021 [22] · who.int/publications/i/item/9789240031593

· WHO. Nutritional Care and Support for People Living with HIV/AIDS: A Training Course. Geneva: WHO; 2009 (nutrition module; updated guidance available via WHO ELENA 2022). — WHO HIV Nutrition 2022 [22a] · who.int/tools/elena/interventions/nutrition-hiv

ONCOLOGY

· Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11–48. — ESPEN 2017 Full Scientific Guideline [19a] · DOI: 10.1016/j.clnu.2016.07.015

· Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: clinical nutrition in cancer. Clin Nutr. 2021;40(5):2898–2913. — ESPEN Cancer 2021 Practical Guideline [19] — current clinical standard · DOI: 10.1016/j.clnu.2021.02.005

Clinical Reference Library

AMPATH Lab Guide · Nutrition Guidelines · Macronutrient Ranges · Pediatric Standards · References [38 sources]

AMPATH LAB REFERENCE GUIDE

Laboratory Reference Ranges

Reference ranges used for FBC, U&Es, LFTs, RFTs, and nutrition-related labs. Malawian hospital context — AMPATH / KCMH institutional ranges.

[A1]AMPATH (Academic Model Providing Access to Healthcare). Laboratory Reference Ranges — Malawian Clinical Context. Moi University / Indiana University Partnership; 2018.

[A2]World Health Organization. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Geneva: WHO; 2011. (WHO/NMH/NHD/MNM/11.1)

[A3]Burtis CA, Ashwood ER, Bruns DE (eds). Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics. 7th ed. St. Louis: Elsevier Saunders; 2015.

DISEASE-SPECIFIC MACRONUTRIENT RANGES

CHO · Fat · Protein targets by condition

Carbohydrate, fat, and protein percentage targets applied condition-by-condition across the adult calculator modules.

[2]McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: SCCM and ASPEN. JPEN J Parenter Enteral Nutr. 2016;40(2):159–211. DOI: 10.1177/0148607115621863

[3]Compher C, Bingham AL, McCall M, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: ASPEN. JPEN J Parenter Enteral Nutr. 2022;46(1):12–41. DOI: 10.1002/jpen.2267

[4]Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the ICU. Clin Nutr. 2019;38(1):48–79. DOI: 10.1016/j.clnu.2018.08.037

[5]Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline: clinical nutrition in the intensive care unit. Clin Nutr. 2023;42(9):1671–1689. DOI: 10.1016/j.clnu.2023.06.021

[10]Ikizler TA, et al. Am J Kidney Dis. 2020;76(3 Suppl 1):S1–S107. — KDOQI 2020 Clinical Practice Guideline for Nutrition in CKD

[13]Plauth M, et al. Clin Nutr. 2019;38(2):485–521. — ESPEN 2019 Clinical Nutrition in Liver Disease

[16]Weimann A, Braga M, Carli F, et al. ESPEN practical guideline: clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745–4761. DOI: 10.1016/j.clnu.2021.03.003

ENERGY & PROTEIN REQUIREMENTS — QUICK REFERENCE

By Condition · Adult

Energy (kcal/kg/day) and protein (g/kg/day) targets for common adult clinical conditions used in the calculator auto-fill logic.

Sources: [2] ASPEN/SCCM 2016 · [3] ASPEN 2022 · [4] ESPEN ICU 2019 · [9] KDIGO AKI 2012 · [18] ESPEN Burns 2013 — see full citations in Nutrition Guideline Sources and Master Reference List below.

REFEEDING SYNDROME RISK & ENTERAL FORMULA GUIDE

NICE CG32 · ASPEN 2020

Refeeding syndrome risk stratification criteria and enteral formula selection guide by clinical condition.

[6]National Institute for Health and Care Excellence (NICE). Clinical Guideline CG32: Nutrition Support for Adults. London: NICE; 2006 (updated 2017). — Refeeding Syndrome Risk Criteria · nice.org.uk/guidance/cg32

[7]da Silva JSV, Seres DS, Sabino K, et al. ASPEN consensus recommendations for refeeding syndrome. Nutr Clin Pract. 2020;35(2):178–195. DOI: 10.1002/ncp.10474

[A4]Bankhead R, et al. JPEN J Parenter Enteral Nutr. 2009;33(2):122–167. — ASPEN Enteral Nutrition Practice Recommendations

PEDIATRIC GROWTH STANDARDS

Fenton 2013 · WHO 2006 · WHO 2007 · Nellhaus 1968

Growth charts and z-score reference data used for WAZ, HAZ, WLZ, head circumference, and MUAC across all pediatric modules.

[29]Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59. DOI: 10.1186/1471-2431-13-59 — Preterm GA 22–50 wk reference (weight, length, HC); harmonised with WHO 2006 at term · PMC (free full text) · Official Fenton Chart (U of Calgary)

[27]WHO Multicentre Growth Reference Study Group; de Onis M (coord.). WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl. 2006;95(450):76–85. DOI: 10.1111/j.1651-2227.2006.tb02378.x — WHO Child Growth Standards 2006 (0–5 years) · PubMed · WHO Charts & Tables

[28]de Onis M, Onyango AW, Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85(9):660–667. DOI: 10.2471/BLT.07.043497 — WHO Growth Reference 5–19 years · PubMed · PMC (free full text) · WHO Charts & Tables

[A5]Nellhaus G. Head circumference from birth to eighteen years: practical composite international and interracial graphs. Pediatrics. 1968;41(1):106–114. DOI: 10.1542/peds.41.1.106 — Historical HC reference (0–18 yr); largely superseded by WHO HC-for-age (0–5 yr) and Fenton 2013 HC-for-GA for preterm. Still used for 5–18 yr context where WHO data unavailable. · PubMed

[A6]WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards: Head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age and subscapular skinfold-for-age. Geneva: WHO; 2007. ISBN 978-92-4-154718-5. — Includes MUAC-for-age tables (3 months–5 years) · who.int/publications/i/item/9789241547185

COMMUNITY-BASED MANAGEMENT OF ACUTE MALNUTRITION (CMAM)

Based on Malawi Ministry of Health CMAM Guidelines (2016) and WHO Wasting Guidelines (2023)

SAM/MAM diagnostic criteria, inpatient and outpatient management protocols, F-75/F-100/RUTF feeding schedules, and growth velocity targets. Adapted for Malawian clinical context.

[30]World Health Organization. Guideline for the Prevention and Management of Wasting and Nutritional Oedema (Acute Malnutrition) in Infants and Children. Geneva: WHO; 2023. https://www.who.int/publications/i/item/9789240082830

[31]Ministry of Health, Republic of Malawi. Guidelines for Community-Based Management of Acute Malnutrition (CMAM) in Malawi. 2nd ed. Lilongwe: MOH; 2016. https://www.fantaproject.org/sites/default/files/resources/Malawi-CMAM-Guidelines-Dec2016.pdf

[32]UNICEF, WHO, World Bank Group. Levels and Trends in Child Malnutrition: Joint Child Malnutrition Estimates (JME). 2023. https://data.unicef.org/resources/jme/

[33]Bhutta ZA, Das JK, Rizvi A, et al. Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Lancet. 2013;382(9890):452–477. https://doi.org/10.1016/S0140-6736(13)60996-4

PEDIATRIC NUTRITION REQUIREMENTS

Energy · Protein · Fluid · Macros · BMR

Age-specific energy (kcal/kg/day), protein (g/kg/day), fluid (mL/kg/day), macronutrient distribution, enteral formula guidance, and BMR equations used in all pediatric calculator sub-modules.

[24]Agostoni C, et al. J Pediatr Gastroenterol Nutr. 2010;51(1):110–122. — ESPGHAN/ESPEN/ESPR Guidelines: Enteral Nutrition in Pediatrics · DOI: 10.1097/MPG.0b013e3181adaee0 · PubMed

[25] Embleton NE et al. ESPGHAN 2022 — see full citation in Preterm Infant Feeding Principles section below.

[A7]Institute of Medicine. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington DC: National Academies Press; 2005. — IOM DRI

[A8]FAO/WHO/UNU. Human Energy Requirements: Report of a Joint FAO/WHO/UNU Expert Consultation. Rome: FAO; 2004. (Food and Nutrition Technical Report Series No. 1)

[A10]Schofield WN. Hum Nutr Clin Nutr. 1985;39(Suppl 1):5–41. — Predicting basal metabolic rate — new standards and review of previous work

[A11]White MS, et al. J Pediatr. 2000;136(5):601–607. — Energy expenditure in 100 ventilated critically ill children: improving the accuracy of predictive equations

PRETERM INFANT FEEDING PRINCIPLES

EN · PN · Micronutrients · Growth · MBDP

EN macro targets, enteral feeding initiation and advancement protocols, micronutrient supplementation, growth velocity targets, post-discharge nutrition, and Metabolic Bone Disease of Prematurity (MBDP) screening. Applied in the Preterm Neonate calculator module.

[25]Embleton NE, et al. J Pediatr Gastroenterol Nutr. 2023;76(2):248–268. — ESPGHAN 2022 Position Paper: Enteral Nutrition in Preterm Infants (EN & PN targets, micronutrients, post-discharge) · DOI: 10.1097/MPG.0000000000003642 · PubMed PMID 36705703

[A12]American Academy of Pediatrics (AAP) Section on Breastfeeding. Pediatrics. 2012;129(3):e827–e841. — Breastfeeding and the Use of Human Milk · DOI: 10.1542/peds.2011-3552 · PubMed PMID 22371471 · Updated 2022 policy: PMID 35921640

[A14]Fenton TR, Anderson D, Groh-Wargo S, Hoyos A, Ehrenkranz RA, Senterre T. An attempt to standardize the calculation of growth velocity of preterm infants — evaluation of practical bedside methods. J Pediatr. 2018;196:77–83. DOI: 10.1016/j.jpeds.2017.10.005 — Compares Average, Exponential, and Early methods; validates against Fenton 2013, Olsen 2010, INTERGROWTH-21st, and WHO 2006 · PubMed

[A15]Backström MC, Kouri T, Kuusela AL, et al. Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity. Acta Paediatr. 2000;89(7):867–873. — MBDP screening: ALP isoenzyme + serum phosphate targets · DOI: 10.1111/j.1651-2227.2000.tb00395.x · PubMed PMID 10943972

References — Nutrition Guidelines & Clinical Sources

Updated 2025

Primary Core Reference

[1] Mahan LK, Raymond JL. Krause & Mahan's Food and the Nutrition Care Process. 16th ed. St. Louis: Elsevier; 2022.

Critical Care & ICU

[2] ASPEN/SCCM 2016 · [3] ASPEN 2022 · [4] ESPEN ICU 2019 · [5] ESPEN ICU 2023 — see full citations in Nutrition Guideline Sources card above.

Refeeding Syndrome

[6] NICE CG32 · [7] ASPEN RS 2020 — see full citations in Refeeding Syndrome & Enteral Formula Guide card above.

Renal Nutrition

[9] KDIGO AKI 2012 · [10] KDOQI 2020 — see full citations in Key References card above.

[11] Fiaccadori E et al. ESPEN Guideline: Nutrition in AKI/CKD. Clin Nutr 2021;40(4):1644–1668.

[12] KDIGO Clinical Practice Guideline for CKD — 2024 Update. Kidney Int 2024;105(Suppl 4S):S117–S314.

Liver Disease

[13] ESPEN Liver 2019 — see full citation in Key References card above.

[14] EASL Clinical Practice Guidelines: Nutrition in Chronic Liver Disease. J Hepatol 2019;70(1):172–193.

Malnutrition Diagnosis

[15] Cederholm T, Jensen GL, Correia MITD, et al. GLIM criteria for the diagnosis of malnutrition — a consensus report from the global clinical nutrition community. JPEN J Parenter Enteral Nutr. 2019;43(1):32–40. [Global diagnostic consensus framework] DOI: 10.1002/jpen.1440

Surgery & Perioperative

[16] ESPEN Surgery 2021 — see full citation in Key References card above.

[17] Weimann A, Bezmarevic M, Braga M, et al. ESPEN guideline on clinical nutrition in surgery — update 2025. Clin Nutr. 2025;53:222–261. DOI: 10.1016/j.clnu.2025.08.029

Burns & Thermal Injury

[18] Rousseau A-F, Losser MR, Ichai C, et al. ESPEN endorsed recommendations: nutritional therapy in major burns. Clin Nutr. 2013;32(4):497–502. [Current evidence-based guideline] DOI: 10.1016/j.clnu.2013.02.012

[18a] Prelack K, Dylewski M, Sheridan RL. Practical guidelines for nutritional management of burn injury and recovery. J Burn Care Res. 2007;28(1):377–396. [Pediatric burns — metabolic basis for Galveston / Curreri Jr. equations] DOI: 10.1097/BCR.0b013e318031a3b1

Pancreatitis

[19b] Arvanitakis M, Ockenga J, Becker T, et al. ESPEN guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr. 2020;39(3):612–631. [Current standard] DOI: 10.1016/j.clnu.2020.03.002

Cardiac & Heart Failure

[19c] McDonagh TA, Metra M, Adamo M, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599–3726. [Current standard guideline] DOI: 10.1093/eurheartj/ehab368

Oncology

[19] Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: clinical nutrition in cancer. Clin Nutr. 2021;40(5):2898–2913. [Current clinical standard — 43 practical recommendations] DOI: 10.1016/j.clnu.2021.02.005

[19a] Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11–48. [Original full scientific guideline] DOI: 10.1016/j.clnu.2016.07.015

Diabetes Mellitus MNT

[20] American Diabetes Association. Standards of Medical Care in Diabetes — 2024. Diabetes Care 2024;47(Suppl 1):S1–S321.

[20a] Jones J. Ch. 30: MNT for Diabetes Mellitus and Hypoglycemia of Nondiabetic Origin. In: Mahan LK, Raymond JL. Krause & Mahan's Food and the Nutrition Care Process. 16th ed. Elsevier; 2022. pp. 626–658.

Infection, HIV & TB

[21] WHO. Guideline: Nutritional Care and Support for Patients with Tuberculosis. Geneva: WHO; 2013.

[22] WHO. Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring: Recommendations for a Public Health Approach. Geneva: WHO; 2021. ISBN 978-92-4-003159-3. who.int/publications/i/item/9789240031593

[22a] WHO. Nutritional Care and Support for People Living with HIV/AIDS (ELENA evidence-informed guidance). Geneva: WHO; 2022 update. who.int/tools/elena/interventions/nutrition-hiv

Pediatric Clinical Nutrition

[23] Mehta NM et al. ASPEN/SCCM Guidelines: Nutrition Support Therapy in the PICU. JPEN 2017;41(5):706–742.

[24a] Corkins MR et al. (eds). ASPEN Pediatric & Neonatal Nutrition Support Core Curriculum. 3rd ed. ASPEN; 2024.

[25] ESPGHAN 2022 Preterm EN — see full citation in Preterm Infant Feeding Principles card above.

Growth Standards

[27] WHO Child Growth Standards 2006 · [28] WHO Growth Reference 5–19yr 2007 · [29] Fenton 2013 Preterm Chart — see full citations in Pediatric Growth Standards card above.

Acute Malnutrition & CMAM

[30] WHO Wasting Guidelines 2023 · [31] Malawi MOH CMAM 2016 — see full citations in Acute Malnutrition & CMAM card above.

Dietary Reference Intakes

[32] IOM. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Protein and Amino Acids. Washington DC: NAP; 2005.

[33] FAO/WHO/UNU. Human Energy Requirements. FAO Food Nutr Tech Rep Series 1. Rome: FAO; 2004.

Food Composition & Regional Tools

[35] Steyn NP, Senekal M. UCT Exchange Lists for Meal Planning. Cape Town: UCT Division of Human Nutrition; 2014.

[36] Government of Malawi. Malawi Food Composition Table. Lilongwe: Department of Nutrition, HIV and AIDS; 2019.

Laboratory Reference Standards

[37] Burtis CA, Ashwood ER, Bruns DE. Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics. 7th ed. Philadelphia: Saunders; 2015.

[38] QECH/KCH Clinical Laboratory Reference Ranges. Blantyre/Lilongwe: MoH Malawi; 2022.

Inline citation keys: ASPEN 2016 [2] · ASPEN 2022 [3] · ESPEN ICU 2019 [4] · ESPEN ICU 2023 [5] · NICE CG32 [6] · ASPEN RS 2020 [7] · KDIGO AKI [9] · KDOQI 2020 [10] · ESPEN Renal 2021 [11] · ESPEN PN Renal 2009 [11a] · KDIGO CKD 2024 [12] · ESPEN Liver 2019 [13] · EASL 2019 [14] · GLIM 2019 [15] · ESPEN Surgery 2021 [16] · ESPEN Surgery 2025 [17] · ESPEN Burns 2013 [18] · Burns Prelack 2007 [18a] · ESPEN Cancer 2021 [19] · ESPEN Cancer 2017 [19a] · ESPEN Pancreatitis 2020 [19b] · ESC Heart Failure 2021 [19c] · ADA 2024 [20] · Krause Ch.30 Diabetes [20a] · WHO HIV Consolidated 2021 [22] · WHO HIV Nutrition 2022 [22a] · ESPGHAN Preterm 2022 [25] · WHO Growth 0–5yr [27] · WHO Growth 5–19yr [28] · Fenton 2013 [29] · WHO Wasting Guidelines 2023 [30]

Clinical Nutrition Databases

Malawi FCT · UCT Exchange Lists · Formula · PN Bags · Global Food Search

Search Food

CATEGORIES

Formula Database

ASPEN · ESPEN · Manufacturer Data

Formula / Product	Category	Route	kcal/mL	kcal/500mL	Protein g/L	Pro %E	CHO g/L	Fat g/L	Osmol mOsm/L	Fibre g/L	Clinical Tags	Key Indication / Notes

Formula Highlights

Quick Reference

Pediatric Nutrition Decision Support

Select population group

Preterm

Neonate

Infant 0–6m

Infant 6–24m

Child 2–5yr

Child 5–10yr

Adolescent 10–17yr

PRETERM NEONATE

Preterm Neonatal Nutrition

Patient Name / ID

Sex

♂ Male

♀ Female

GA at Birth * (wks+days)

wks

Date of Birth

Measurement Date

Day of Life (auto)

MEASUREMENTS

Growth Monitoring

Birth Weight *

g

Enter BW to classify ELBW/VLBW/LBW

Current Weight *

g

Crown-Heel Length

cm

Head Circumference

cm

Previous Weight

g

Days Since Prev. Weight

CLINICAL CONTEXT

Feeding · Ventilation · Stress

Primary Diagnosis / Condition

Nutritional Phase

Feeding Route

Ventilatory Status

Thermal Environment

Stress Factor

Starvation Days

days

On Dextrose IV?

Yes No

Current EN Volume (for phase auto-class)

mL/kg/d

Enter EN volume → phase auto-classified

LABORATORY

Optional · improves accuracy

Blood Glucose

mg/dL

Sodium (Na⁺)

mEq/L

Potassium (K⁺)

mEq/L

Calcium (Ca²⁺)

mmol/L

Phosphate (PO₄)

mmol/L

Alkaline Phosphatase

U/L

TERM NEONATE

WHO 2006 · 0–28 days

Patient Name / ID

Sex

♂ Male

♀ Female

Date of Birth *

Assessment Date

Enter DOB to compute age

Birth Weight *

g

Current Weight *

g

Length / Height

cm

Head Circumference

cm

Feeding Method

Clinical Status

Primary Diagnosis / Condition

INFANT 1–6 MONTHS

WHO 2006 · WAZ · LAZ · WLZ

Patient Name / ID

Sex

♂ Male

♀ Female

Date of Birth *

Assessment Date

Enter DOB to compute age

Weight *

kg

Recumbent Length *

cm

Head Circumference

cm

Feeding

Birth Weight

g

Primary Diagnosis / Condition

INFANT 6–24 MONTHS

WHO 2006 · WHZ · WLZ · SAM/MAM

Patient Name / ID

Sex

♂ Male

♀ Female

Date of Birth *

Assessment Date

Enter DOB to compute age

Weight *

kg

Length (recumbent) *

cm

MUAC

mm

Head Circumference

cm

Bilateral Oedema

No

+ (mild)

++ (mod)

+++ (sev)

Breastfeeding

Yes

No

Meals per day

Food Groups (last 24h)

SAM Phase (if applicable)

Primary Diagnosis / Condition

CHILD 2–5 YEARS

WHO 2006 · WHZ · BMI-for-age · SAM/MAM

Patient Name / ID

Sex

♂ Male

♀ Female

Date of Birth *

Assessment Date

Enter DOB to compute age

Weight *

kg

Height (standing) *

cm

MUAC *

mm

SAM <115mm · MAM 115–124mm

Bilateral Oedema *

No

+

++

+++

SAM Phase

Starvation Days

days

Primary Diagnosis / Condition

LABORATORY

Optional

Hemoglobin

g/dL

Blood Glucose

mg/dL

Potassium (K⁺)

mEq/L

Sodium (Na⁺)

mEq/L

CHILD 5–10 YEARS

WHO 2007 · BMI-for-age · SAM/MAM

Patient Name / ID

Sex

♂ Male

♀ Female

Age / Date of Birth *

Enter DOB or type age directly

Assessment Date

Weight *

kg

Height *

cm

MUAC

mm

Bilateral Oedema

No

Yes

Physical Activity

Health Status

Physiological Stress Level

Primary Diagnosis / Condition

ADOLESCENT 10–17 YEARS

WHO 2007 · BMI-for-age · SAM/MAM

Patient Name / ID

Sex

♂ Male

♀ Female

Age / Date of Birth *

Enter DOB or type age directly (10–17 years)

Assessment Date

Weight *

kg

Height *

cm

MUAC

mm

Bilateral Oedema

No

Yes

Tanner Stage

Used for growth context in 10–17yr range

Activity Level

Health Status

Physiological Stress Level

Menstrual Status (girls)

Pregnancy / Lactation

Primary Diagnosis / Condition

Adjusts energy factor, protein & micronutrient targets for condition

ANTHROPOMETRY & BODY COMPOSITION

Height & Weight Estimation · Amputation AdjBW · Obesity AdjBW · Nitrogen Balance

About This Module

All Age Groups

This module provides indirect anthropometric estimation tools for patients where direct measurement of height or weight is not possible — including bedbound, elderly, amputee, or critically ill patients.

Height Estimation

• Knee Height — best for adults 19–60 yrs; accounts for sex & ethnicity (Lee & Nieman)

• Demi-Span — fingertip to mid-sternum; sex & age-corrected (Gibson 2005)

• Ulna Length — olecranon to ulnar styloid; sex & age lookup (BAPEN/Elia 2003)

Weight & Other Tools

• KH + MAC — weight from knee height & mid-arm circumference; ages 6–80 yrs

• Amputation AdjBW — corrects measured weight for missing limb segment(s)

• Obesity AdjBW — Glynn (25% lean) or Barak (50% lean) correction

• Nitrogen Balance — 24h urinary urea method (ESPEN)

↳ Using results in other modules — Transfer estimated values manually into the relevant module — copy the result into the height or weight field of the Adult Calculator, Paediatric Module, or Enteral as appropriate. For Paediatric patients, use KH + MAC weight estimation (ages 6–18) or the Ulna lookup table and enter the result manually in the Paediatric Module. The Enteral module inherits weight from the Adult Calculator automatically. Estimated values carry inherent error (SEE ±5–11 kg for weight). Always prefer direct measurement where feasible.

Patient Sex

Used by Knee Height, Demi-Span & Ulna equations

♂ MALE

♀ FEMALE

Height Estimation

① Knee Height (Lee & Nieman, 1996)

Knee Height (cm)

cm

Age (years)

Ethnicity

Measure: patient supine, left knee & ankle at 90° · Valid age range 19–80 yrs · Accounts for sex, age & ethnicity

② Demi-Span (Gibson, 2005)

Demi-Span (cm)

cm

Age (years)

Measure: fingertip → mid-sternum notch, arm horizontal at shoulder height · Sex & age-corrected · Use when arms unaffected

③ Ulna Length (BAPEN / Elia, 2003)

Ulna Length (cm)

cm

Age from the main calculator is used automatically for the <65 / ≥65 cut-off

Measure: olecranon process → ulnar styloid, arm bent 90° across chest · Sex & age lookup table (BAPEN)

Weight Estimation (KH + MAC — Lee & Nieman)

Knee Height (cm)

MAC (cm)

Age group

Ethnicity

Use 65+ weight equations (CC, SSF) when available

Amputation — Adjusted Body Weight

Residual (measured) weight (kg)

Amputated part(s)

Formula: Adj.BW = current weight ÷ (100 − % amputation) × 100 · Lee & Nieman

Adjusted BW for Obesity

Actual Weight (kg)

Height (cm)

Sex

• Eq. a (Glynn, 1999 — 25% lean): AdjBW = IBW + 0.25 × (Actual − IBW) | Dietitian standard

• Eq. b (Barak, 2002 — 50% lean): AdjBW = IBW + 0.50 × (Actual − IBW) | More generous protein target

IBW: Devine formula · BMI >30 required · Lee & Nieman

Nitrogen Balance & Urinary Nitrogen

24h Urine Volume (L)

Urinary Urea (mmol/L)

Protein Intake (g/day)

Formula: TUN = [Vol × Urea × 0.028] × 1.2 · Total N output = TUN + 4g (obligatory losses)

Nutrition-Focused Physical Exam

ASPEN NFPE — 11-domain malnutrition assessment tool

Clinical References

• Knee Height → Stature: Lee & Nieman (1996) — sex/ethnicity-specific equations, age 19–60.

• Demi-span → Stature: Gibson (2005) — fingertip to mid-sternum with arm horizontal.

• Ulna Length → Stature: Elia / BAPEN (2003) — age & sex look-up table.

• Weight from KH + MAC: Lee & Nieman (1996) — validated ages 6–80.

• Amputation AdjBW: Lee & Nieman — Adj.BW = current ÷ (100 − %amp) × 100.

• Obesity AdjBW: Glynn (1999) 25% lean; Barak (2002) 50% lean.

• Nitrogen Balance: TUN = Vol × Urea(mmol/L) × 0.028 × 1.2; N out = TUN + 4 g.

Source: Krause & Mahan Food & Nutrition Care Process 16th ed. (2022) Ch. 5; BAPEN MUST 2003.

NUTRITION-FOCUSED PHYSICAL EXAM

ASPEN NFPE · 11-Domain Malnutrition Assessment · AND/ASPEN 2012

NFPE Assessment

ASPEN NFPE — Grade each finding: 0 = Normal · 1 = Mild · 2 = Moderate · 3 = Severe. At least 2 characteristics in the same severity category support a malnutrition diagnosis (ASPEN/AND 2012). The overall impression summary auto-generates below.

NFPE IMPRESSION

Complete the exam above — impression will auto-generate.

Clinical References

• NFPE Consensus: Mordarski & Wolff — ASPEN Pocket Guide to Nutrition Assessment of the Patient with Obesity (2015).

• Malnutrition Diagnosis: White et al. — AND/ASPEN Consensus Statement. JPEN 2012;36(3):275–283.

• GLIM Criteria: Cederholm et al. JPEN 2019;43(1):32–40.

Source: Krause & Mahan Food & Nutrition Care Process 16th ed. (2022) Ch. 5.