What is a fortified diet in NHS? A Guide to Nutritional Support

December 21, 2025 •

4 min read

According to UK healthcare professionals, a fortified diet is a 'Food First' strategy designed to increase the calorie and protein content of everyday meals without significantly increasing the portion size. This approach is a key part of NHS nutritional guidance for specific patient groups to prevent or treat malnutrition.

Quick Summary

An NHS-prescribed fortified diet adds extra energy and protein to regular food and drink using fortifiers like milk powder, cheese, and cream. It is primarily for individuals at risk of malnutrition, such as those with a poor appetite, weight loss, or higher nutritional needs.

Key Points

Food First Strategy: The NHS fortified diet uses everyday ingredients to increase calorie and protein density in standard meals.
Targeted Patients: This diet is recommended for individuals at risk of malnutrition, including those with poor appetite, weight loss, or increased energy needs.
Practical Ingredients: Common fortifiers include skimmed milk powder, full-fat dairy products, butter, cheese, and nut butters.
Higher Acceptance: Because it uses familiar foods, a fortified diet often has better patient acceptance than commercial oral supplements.
Professional Guidance: Always seek advice from a healthcare professional, like an NHS dietitian, before starting a fortified diet, especially for those with complex health needs.
Avoid 'Diet' Products: For fortification, use full-fat and full-sugar options to maximise the calorie and nutrient boost.
Watch for Weight Gain: The diet should be monitored and adjusted to prevent excessive weight gain in patients.

Understanding the Concept of Fortified Diet

Within the NHS, the term fortified diet refers to a practical and effective method of boosting the nutritional density of food and drink. Instead of adding vitamins and minerals in a factory setting, as with some commercial products, this strategy involves a 'Food First' approach using everyday, household ingredients to increase calories and protein at home or in a care setting. The goal is to provide extra nourishment to individuals who cannot eat large volumes of food due to poor appetite, illness, or other health conditions. By enriching existing meals, the diet helps combat weight loss and malnutrition without overwhelming the person with larger portions.

Who Needs a Fortified Diet?

The NHS recommends a fortified diet for several specific groups of people who are at risk of malnutrition or have increased nutritional requirements. Healthcare professionals, often dietitians, will assess a patient's nutritional status before recommending this approach.

Individuals with Poor Appetite: People who eat less than usual due to illness, treatment, or age-related changes can benefit significantly.
Those Experiencing Unintentional Weight Loss: A fortified diet helps reverse weight loss and maintain a healthy weight.
Patients Recovering from Illness or Surgery: Recovery often requires a higher intake of calories and protein to aid tissue repair and regain strength.
Elderly Patients in Care Settings: Many older adults struggle with reduced appetite and smaller portion sizes, making a fortified diet a suitable strategy for weight maintenance.
Patients with Increased Energy Needs: Conditions such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), and some cancers increase the body's energy demands.

Practical Methods for Food Fortification

Fortifying meals is straightforward and involves using nutrient-dense ingredients. Here are some effective NHS-approved techniques:

Dairy-Based Fortification: Fortified milk is a staple. To make it, add 4 heaped tablespoons of skimmed milk powder to 1 pint of full-fat milk. This can then be used in cereals, porridge, soups, and milkshakes. Adding grated cheese to soups, stews, or mashed potato is another simple way to boost protein and calories. Double cream can be added to desserts, hot drinks, or scrambled eggs for extra energy.
Fat-Based Fortification: Incorporating extra fats is an easy way to increase calorie intake. Add extra butter, margarine, or oil to vegetables, toast, potatoes, and sauces. Nut butters on toast or crackers also provide a significant calorie and protein boost.
Snack and Drink Fortification: Encouraging regular, nutrient-dense snacks and drinks is a core part of the strategy. Options include full-fat yoghurts, cream cheese on crackers, and nourishing milky drinks made with the fortified milk recipe. Sugary options like honey, jam, and syrup can also be used in moderation to encourage intake.

Fortified Diet vs. Oral Nutritional Supplements

When addressing nutritional deficiencies, the NHS often considers two main strategies: a fortified diet and prescribed oral nutritional supplements (ONS). The table below compares these two approaches.


Aspect	Fortified Diet (Food First)	Oral Nutritional Supplements (ONS)
Application	Involves adding everyday ingredients to existing foods and drinks.	Ready-made, commercially prepared liquids or powders.
Initial Approach	Preferred first line of defence against malnutrition.	Used when a fortified diet is unsuccessful or insufficient.
Patient Acceptance	Generally higher, as it uses familiar flavours and textures.	Can sometimes have a medicinal taste and lower palatability.
Cost	Uses standard, widely available household ingredients.	Can be costly for the NHS, and availability may vary.
Flexibility	Allows for a wide variety of meals and personalisation based on preferences.	Less flexible, as options are limited to available product flavours.
Energy Boost	Primarily focused on increasing calories and protein.	Can target specific nutrients and provide a concentrated energy boost.

How to Implement a Fortified Diet Safely

Implementing a fortified diet requires careful consideration to ensure it is both safe and effective. It's crucial to follow guidance from a healthcare professional, especially a registered dietitian.

Key Considerations for Implementation

Start Small: Begin by fortifying a few favourite meals or snacks and gradually increase the number as the patient's tolerance improves.
Observe and Monitor: Regularly assess how well the patient is eating and monitor their weight and overall well-being. The diet should be discontinued if they start to gain excessive weight.
Use Full-Fat and High-Sugar Options: Unlike general healthy eating advice, a fortified diet often recommends full-fat dairy and sugar to increase energy intake. Dental hygiene is important to manage any increased sugar consumption.
Consider Swallowing Difficulties: If the patient has dysphagia, or swallowing difficulties, it is essential to ensure the fortified food maintains the correct texture and consistency. Always seek a healthcare professional's advice in such cases.

Conclusion: A 'Food First' Approach to Malnutrition

A fortified diet, as supported by NHS guidelines, is a vital 'Food First' strategy for managing and preventing malnutrition in vulnerable patient groups. By simply adding nutrient-dense ingredients like milk powder, cream, and cheese to everyday meals and snacks, this approach can effectively increase calorie and protein intake without forcing larger portions. It is a highly practical, flexible, and often more palatable option than relying solely on oral nutritional supplements. The success of a fortified diet depends on careful implementation, regular monitoring, and personalised attention to the patient's needs and preferences, often guided by a healthcare professional.

Useful Resources

For more detailed information, the East London NHS Foundation Trust provides a comprehensive guide on food fortification methods:

East London NHS Foundation Trust: Food Fortification

Consulting with a healthcare provider or a dietitian is the best course of action for anyone considering a fortified diet, ensuring it is tailored to their specific health requirements.

Frequently Asked Questions

The main purpose is to prevent and treat malnutrition by increasing the calorie and protein content of a person's food and drink without increasing the overall portion size.

Regular healthy eating focuses on a balanced diet with lower fat and sugar, as shown in the Eatwell Guide. A fortified diet, however, uses full-fat and full-sugar ingredients to provide extra energy for those who need it, moving away from typical low-fat recommendations.

Yes, a fortified diet can be used for children who are underweight or have poor appetites, but it should be under the guidance of a healthcare professional, such as a paediatric dietitian. Fortified milk is a common technique used.

To make fortified milk, add four heaped tablespoons of skimmed milk powder to one pint of full-fat milk and stir until dissolved. This can then be used in recipes, on cereals, or in drinks.

The main risk is unintended or excessive weight gain if the diet is not properly monitored. Patients with certain conditions, like diabetes, should also be carefully managed under professional supervision due to the higher sugar and fat content.

A fortified diet is typically considered when a person is experiencing unexplained weight loss, has a very poor appetite, or is at high risk of malnutrition. A healthcare professional will make this recommendation.

Yes, fortified foods are particularly beneficial for older adults who often have reduced appetites and can struggle to maintain their weight. The diet can help prevent muscle loss and combat malnutrition in this population.