The detection and prevention of malnutrition are critical components of patient care, impacting everything from recovery time to overall health outcomes. The Malnutrition Universal Screening Tool (MUST) provides a standardized, five-step method for assessing an individual's nutritional status across various care settings, including hospitals, care homes, and the community. By following these steps, healthcare providers can quickly and effectively identify those at risk and implement the necessary interventions.
The 5-Step MUST Assessment Process
The MUST process is structured to be both comprehensive and easy to apply, ensuring that a person's nutritional risk is accurately determined. Each of the first three steps yields a score, which are then combined in the fourth step to arrive at an overall risk category. The final step provides clear management guidance.
Step 1: Body Mass Index (BMI) Score
This initial step involves calculating the patient's BMI to assess their current weight status. The BMI is determined by dividing an individual's weight in kilograms by the square of their height in meters ($$BMI = kg/m^2$$). Depending on the result, a score is assigned:
- Score 0: BMI > 20.0 (or > 30 for obesity)
- Score 1: BMI 18.5–20.0
- Score 2: BMI < 18.5
In cases where height and weight cannot be accurately measured, a recent documented or reliably reported measurement can be used. Alternative measurements, such as mid-upper arm circumference (MUAC), can also be used to estimate the BMI category.
Step 2: Unplanned Weight Loss Score
Step two focuses on recent, unintentional weight loss, which is a key indicator of developing malnutrition. The healthcare provider assesses the percentage of weight lost over the last 3 to 6 months.
- Score 0: Unplanned weight loss < 5%
- Score 1: Unplanned weight loss 5–10%
- Score 2: Unplanned weight loss > 10%
Step 3: Acute Disease Effect Score
This step addresses the impact of a patient's current illness on their nutritional intake. A score is assigned if the individual is acutely ill and has had, or is likely to have, little to no nutritional intake for more than five days. This factor accounts for the immediate, high-risk nutritional challenges posed by severe illnesses or medical procedures.
- Score 0: No acute disease effect
- Score 2: Acute disease effect present
Step 4: Overall Risk Score
In this step, the scores from the first three stages are added together to get a total MUST score. This single number places the individual into one of three risk categories:
- Low Risk: Score = 0
- Medium Risk: Score = 1
- High Risk: Score ≥ 2
For patients where objective measurements were impossible, a subjective clinical assessment is used to determine the risk category.
Step 5: Management Guidelines
Based on the overall risk score, an appropriate care plan is developed. The management approach is tailored to the individual's specific level of risk, with more intensive interventions for those at higher risk.
- Low Risk: Continue routine care, monitor weight regularly, and re-screen if the patient's condition changes.
- Medium Risk: Observe dietary intake for 3 days. If intake is adequate, continue monitoring. If intake is poor, set goals to improve intake and consider a referral to a dietitian.
- High Risk: Take immediate action. Refer the patient to a dietitian or nutritional support team, implement strategies to improve nutritional intake, and closely monitor progress.
Comparing MUST to Other Screening Tools
While MUST is a highly effective and widely used tool, other screening methods also exist, each with specific strengths. The right tool often depends on the clinical setting and patient population.
| Feature | Malnutrition Universal Screening Tool (MUST) | Mini Nutritional Assessment (MNA®) | Nutritional Risk Screening (NRS 2002) |
|---|---|---|---|
| Target Population | General adult population across all settings. | Elderly patients (age 65 and above). | Hospitalized patients. |
| Key Parameters | BMI, unplanned weight loss, acute disease effect. | BMI, weight loss, mobility, dietary intake, psychological stress, presence of acute disease. | BMI, recent weight loss, severity of disease, age over 70. |
| Complexity | Simple, quick, and easy to apply. | Original 18-question and shorter 6-question version available; more detailed than MUST. | Relatively simple, focusing on key risk factors in a hospital context. |
| Primary Strength | Universal applicability and ease of use, ensuring broad adoption. | High accuracy for identifying malnutrition risk specifically in the elderly. | Endorsed by ESPEN for use in hospital settings. |
Why Regular Screening is Vital
Early identification of malnutrition is crucial for preventing a cascade of negative health outcomes, including increased infections, impaired wound healing, longer hospital stays, and higher mortality rates. Regular nutritional screening with tools like MUST allows healthcare teams to be proactive rather than reactive, intervening before a patient's nutritional status deteriorates significantly. This not only improves patient outcomes but also leads to more efficient use of healthcare resources.
Conclusion
For any healthcare professional or caregiver seeking to understand what nutrition screening tool has 5 steps, the answer is the Malnutrition Universal Screening Tool (MUST). Its straightforward, five-step process provides a reliable and accessible method for identifying individuals at risk of malnutrition. By systematically assessing BMI, weight loss, and the impact of acute disease, MUST enables a timely and targeted response, ensuring that nutritional care is an integral and effective part of overall health management. The use of validated tools like MUST is a cornerstone of modern nutrition dietetics, empowering better health outcomes for a wide range of patients.
For more detailed information, the official Malnutrition Universal Screening Tool resources are available from the British Association for Parenteral and Enteral Nutrition (BAPEN).
