The Malnutrition Universal Screening Tool (MUST) is a multi-step screening process developed by the Malnutrition Advisory Group (a standing committee of BAPEN) to identify adults who are malnourished, at risk of malnutrition, or obese. This assessment is standard practice in many healthcare settings, including hospitals, care homes, and community clinics. The entire process consists of five straightforward steps, which systematically gather information, calculate a risk score, and determine the appropriate management plan.
The Five Steps of a MUST Assessment
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BMI Score: The first step involves measuring the patient's height and weight to calculate their Body Mass Index (BMI). A chart is then used to assign a score based on the result. Scores are 0 for BMI >20 kg/m$^2$ (>30 kg/m$^2$ for obese), 1 for BMI 18.5-20 kg/m$^2$, and 2 for BMI <18.5 kg/m$^2$. If direct measurements are not possible, alternative methods like mid-upper arm circumference (MUAC) or self-reported data can be used.
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Weight Loss Score: The second step assesses unplanned weight loss over the past 3 to 6 months. A score is assigned based on the percentage of loss: 0 for <5%, 1 for 5–10%, and 2 for >10%. This information can come from medical records or direct questioning.
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Acute Disease Effect Score: This step considers the impact of acute illness on nutritional intake. A score of 2 is given if the patient is acutely ill and has had, or is likely to have, minimal or no intake for more than five days, indicating increased malnutrition risk. Otherwise, the score is 0.
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Overall Risk Score: The scores from the first three steps are added to determine the overall risk: Low (0), Medium (1), or High ($\ge$2).
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Management Guidelines: The final step is developing a tailored care plan based on the risk category. Actions vary, from routine care for low risk to immediate dietitian referral for high risk.
Comparison of MUST Risk Categories and Management
| Risk Category | Total Score | Initial Management | Rescreening Frequency |
|---|---|---|---|
| Low Risk | 0 | Routine clinical care. | Annually in the community, monthly in care homes, weekly in hospitals. |
| Medium Risk | 1 | Observe dietary intake (up to 3 days). Provide dietary advice. | Monthly in care homes, every 2-3 months in the community. More frequent if intake is inadequate. |
| High Risk | $\geq 2$ | Refer immediately to a dietitian or nutritional support team. Provide intensive dietary support. | Weekly in hospitals, monthly in care homes or community settings. |
Practical Application of the MUST Assessment
Accurate data collection and scoring are essential, involving healthcare professionals, patients, and caregivers. Alternative methods should be used if direct communication is not possible. Thorough documentation of findings and the care plan ensures continuous care.
When to use a MUST assessment
MUST screening is recommended upon admission, at regular intervals, or when clinical concerns arise. Signs like unexplained weight loss or reduced appetite may prompt an assessment. Following the five steps allows for timely intervention to prevent severe malnutrition and improve patient outcomes.
Conclusion
The five-step MUST assessment is a simple yet powerful tool for identifying and managing adult malnutrition risk. By combining scores for BMI, weight loss, and acute disease impact, it generates a risk score that informs a personalized management plan. Adhering to these steps facilitates early detection and effective nutritional support, enhancing patient health. More detailed guidelines are available on the official BAPEN website.
