Malnutrition Screening: A Crucial First Step
Malnutrition screening is a rapid and simple process designed to identify individuals at nutritional risk who may require a more detailed nutritional assessment. Contrary to popular belief, you cannot determine a person's nutritional status simply by looking at them. Standardized, validated tools are necessary for an objective and reliable evaluation. The number of steps varies depending on the specific tool used, with the Malnutrition Universal Screening Tool (MUST) being a widely adopted example featuring a clear, five-step process.
The 5 Steps of the Malnutrition Universal Screening Tool (MUST)
The Malnutrition Universal Screening Tool (MUST) is a five-step process used to identify adults who are malnourished, at risk of malnutrition, or obese across various care settings. The tool provides a systematic way to determine a patient's overall risk based on three key criteria: BMI, unintentional weight loss, and acute disease effect.
Here is a breakdown of the five steps involved in completing a MUST screening:
- Calculate BMI Score: The first step is to measure the patient's height and weight to calculate their Body Mass Index (BMI). A score is assigned based on the result: 0 for a BMI of >20 kg/m² (>30 for obese), 1 for 18.5–20 kg/m², and 2 for <18.5 kg/m². Alternative measurements, like Mid Upper Arm Circumference (MUAC), can be used if height and weight cannot be obtained accurately.
- Assess and Score Weight Loss: Next, healthcare professionals determine the patient's percentage of unplanned weight loss over the past 3 to 6 months. This is scored based on the percentage lost: 0 for <5%, 1 for 5–10%, and 2 for >10%.
- Determine Acute Disease Effect: This step identifies whether the patient has been acutely ill and has had, or is likely to have, no nutritional intake for more than five days. A score of 0 is given if there is no acute illness or limited nutritional intake, while a score of 2 is given if there is.
- Add Scores to Determine Overall Risk: The scores from the first three steps are added together to produce an overall MUST score. This total score dictates the patient's risk category: low risk (score 0), medium risk (score 1), or high risk (score 2 or more).
- Use Management Guidelines: Based on the risk category identified in step 4, specific management guidelines are used to develop a care plan. This can include dietary modifications, nutritional support, or referral to a dietitian.
Comparison of Malnutrition Screening Tools
While MUST is a prominent example, other tools exist, each with a different number of steps or questions and a specific target audience. The approach to malnutrition screening must be tailored to the patient and care setting.
| Feature | Malnutrition Universal Screening Tool (MUST) | Mini Nutritional Assessment-Short Form (MNA-SF) | Malnutrition Screening Tool (MST) |
|---|---|---|---|
| Number of Steps | 5 steps | 6 questions | 2 questions |
| Primary Target | Adults in all care settings (hospital, community, etc.) | Elderly (age 65+) in all care settings | Adult hospital patients |
| Core Criteria | BMI, unplanned weight loss, acute disease effect | Changes in appetite, weight loss, mobility, stress, neuropsychological issues, BMI | Unplanned weight loss, poor appetite |
| Output | Low, medium, or high risk score | Malnourished, at-risk, or normal nutritional status | At-risk or not at-risk |
| Speed of Use | Quick and systematic for trained users | Very quick, approximately 5 minutes | Extremely quick and simple |
| Key Benefit | Comprehensive for general adult population | Highly validated for the elderly population | Very simple, can be used by various staff |
Differentiating Screening from Nutritional Assessment
It is vital to understand that a screening tool does not provide a definitive diagnosis of malnutrition; rather, it identifies the risk of malnutrition. A comprehensive nutritional assessment, which is triggered by a positive screening result, is a more in-depth process used by dietitians to diagnose and plan interventions.
A full nutritional assessment typically includes these components:
- Anthropometric Measurements: Detailed measurements of body size and composition, such as height, weight, and circumferences.
- Biochemical Parameters: Blood tests to analyze nutrient levels, such as protein and electrolytes.
- Clinical Evaluation: A physical examination and review of medical history to identify signs of nutritional deficiencies and underlying conditions.
- Dietary History: A thorough review of a patient's food and fluid intake, dietary habits, and any related difficulties.
Conclusion
Knowing how many steps are in a malnutrition screening tool depends on which tool is being used, but the core objective remains the same: to efficiently identify and categorize nutritional risk. The 5-step MUST provides a robust framework for adults across care settings, while tools like the MNA-SF are tailored for specific populations such as the elderly. The number of steps is a direct reflection of the tool's intended use and depth of inquiry. By utilizing these evidence-based tools, healthcare systems can implement timely and effective nutritional interventions, improving patient outcomes and overall quality of life. For further authoritative information on this subject, the British Association for Parenteral and Enteral Nutrition (BAPEN) is a highly respected source.
