How we made the decision

We check our guidelines regularly to ensure they remain up to date. We based the decision on surveillance 12 years after the publication of NICE's guideline on nutrition support for adults (NICE guideline CG32) in 2006.

For details of the process and update decisions that are available, see ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual.

Previous surveillance update decisions for the guideline are on our website.


We found 80 studies in a search for randomised controlled trials and systematic reviews published between 23 September 2013 and 18 October 2016. We also included 7 relevant studies from a total of 44 identified by members of the guideline committee who originally worked on this guideline.

We also considered evidence identified in previous surveillance 2, 5 and 8 years after publication of the guideline. This included 132 studies identified by search.

From all sources, we considered 219 studies to be relevant to the guideline.

We also checked for relevant ongoing research, which will be evaluated again at the next surveillance review of the guideline.

See appendix A: summary of evidence from surveillance for details of all evidence considered, and references.

Views of topic experts

We considered the views of topic experts, including those who helped to develop the guideline and other correspondence we have received since the publication of the guideline.

Views of stakeholders

Stakeholders commented on the decision not to update the guideline. Overall, 11 stakeholders commented. See appendix B for stakeholders' comments and our responses.

Eleven stakeholders commented on the proposal to not update the guideline: 5 agreed with the decision; 5 disagreed with the decision; and 1 provided comments but not an opinion on the proposal. Ten stakeholders commented on the proposal to put the guideline on the static list: 4 agreed with the decision; and 6 disagreed with the decision.

Reasons for disagreements with the decision not to update included requests:

  • to update recommendations on refeeding (no evidence was supplied, and 1 issue was considered a matter for local implementation)

  • to review appropriate foods for oro-pharyngeal dysphagia (no evidence was supplied)

  • to increase the frequency of malnutrition screening in care homes (the guideline already promotes continuous monitoring in care homes)

  • to add to and update tools supporting the guideline (surveillance does not examine supporting tools, but information was passed to the relevant NICE team, and the stakeholder was pointed to the NICE endorsement programme)

  • to make the guideline mandatory (NICE guidelines are not and cannot be made mandatory)

  • to update the area of nutrition support in critically ill patients (current surveillance examined several recent studies and evidence was deemed unlikely to impact the guideline – no further evidence was supplied by the stakeholder)

  • to discuss carrying out mental capacity assessments (the guideline currently refers to a 2001 Department of Health guide on consent, which was updated in 2009 and now makes reference to the Mental Capacity Act 2005 including mental capacity assessments – a referral to the new edition will be added to the guideline)

  • to update safety information on tube feeding (the guideline will be updated to refer to the latest safety advice)

  • to add CORTRAK technology to recommendations on feeding tube placement (NICE has assessed CORTRAK in medtech innovation briefing 48, which is aligned with the recommendations in CG32 on confirmation of tube placement).

Relevant ongoing research was identified to NICE, therefore the guideline will not be placed on the static list.

See ensuring that published guidelines are current and accurate in developing NICE guidelines: the manual for more details on our consultation processes.

NICE Surveillance programme project team

Sarah Willett (until February 2017) and Kay Nolan
Associate Director

Philip Alderson
Consultant Clinical Adviser

Katrina Sparrow (until February 2017) and Judith Thornton
Technical Adviser

Patrick Langford
Technical Analyst

The NICE project team would like to thank the topic experts who participated in the surveillance process.

ISBN: 978-1-4731-2520-9

This page was last updated: 27 July 2017