Nutrition Diet: Uncovering When Was The Must Tool Introduced and Its Impact

October 26, 2025 •

3 min read

According to the British Association for Parenteral and Enteral Nutrition (BAPEN), malnutrition affects over three million people in the UK annually, a costly health issue. The development of a reliable screening tool was crucial, and answering the question of when was the must tool introduced? reveals a pivotal moment for nutritional assessment in healthcare.

Quick Summary

The Malnutrition Universal Screening Tool (MUST) was launched by BAPEN in 2003 to provide a standardized and effective method for identifying malnutrition risk across adult patient populations in various care settings.

Key Points

Introduction Date: The MUST tool was developed and launched by BAPEN in 2003.
Standardized Screening: Its introduction standardized the approach to nutritional assessment in adults across various healthcare settings.
Five-Step Process: The tool assesses malnutrition risk using five steps: BMI, unintentional weight loss, acute disease effect, overall risk, and management guidelines.
Broad Applicability: MUST is versatile, used by a range of healthcare professionals in hospitals, care homes, and community care.
Improved Outcomes: By facilitating early intervention, the tool helps improve patient outcomes and reduces healthcare costs associated with malnutrition.
Limitations: While effective, MUST does not screen for vitamin or mineral deficiencies and relies on accurate data for correct scoring.

The Origin of the MUST Tool

Before the early 2000s, there was no single standard method for identifying malnutrition in adult patients, leading to inconsistent care and missed diagnoses. Given the significant health consequences of malnutrition, including increased complications and mortality, the British Association for Parenteral and Enteral Nutrition (BAPEN) developed the Malnutrition Universal Screening Tool (MUST). MUST was launched in 2003 and has since become a standard in the UK and is used globally, endorsed by major healthcare organizations.

How the MUST Tool Works

Since when was the must tool introduced in 2003, it has provided a systematic, five-step process for healthcare professionals to assess malnutrition risk in adults across different settings. The steps are designed for ease of use and clinical validity:

Calculate Body Mass Index (BMI) Score: Determine BMI from height and weight, assigning a score. Mid-upper arm circumference is an alternative if BMI is not measurable.
Note Unplanned Weight Loss: Assess recent unplanned weight loss over 3-6 months and assign a score based on the percentage lost.
Assess Acute Disease Effect: Consider if acute illness has led to little or no nutritional intake for over five days, resulting in a high-risk score.
Determine Overall Risk Score: Sum the scores from the previous steps to classify the patient into low, medium, or high risk for malnutrition.
Formulate a Care Plan: Implement management guidelines based on the overall risk score.

Impact on Nutritional Care and Diet Planning

The introduction of the MUST tool transformed nutritional care by promoting proactive identification and intervention. Standardized screening ensures early detection of at-risk patients, enabling tailored nutrition diet plans to improve health outcomes. For example, a high MUST score may trigger a dietitian referral for a specialized plan, while a low score suggests routine monitoring. The tool improves communication among healthcare teams and has made nutritional screening a routine part of care.

Comparison: MUST Tool vs. Other Screening Tools

While MUST is widely used, other screening tools exist. Comparing them highlights MUST's specific applications and characteristics.


Feature	MUST Tool	Mini Nutritional Assessment (MNA)	Nutrition Risk Screening 2002 (NRS-2002)
Target Population	All adults across all care settings	Primarily older adults and the elderly	All hospitalized adults
Components	BMI, unintentional weight loss, acute disease effect	BMI, weight loss, mobility, dietary intake, psychological stress	BMI, weight loss, food intake, severity of disease, age
Ease of Use	Simple, quick, and can be used by non-specialists	More complex, requires more detailed information	Moderate complexity, includes disease-specific criteria
Specificity	Identifies risk of under- or over-nutrition	Specifically designed for malnutrition risk in the elderly	Identifies both malnutrition risk and severity of illness

Advantages and Limitations of the MUST Tool

Advantages:

Versatility: Applicable to all adult populations and care settings.
Simplicity: Quick and easy for various healthcare professionals.
Validity: Well-validated, reliable, and reproducible.
Obesity Detection: Also identifies obesity risk.

Limitations:

No Micronutrient Assessment: Does not screen for vitamin or mineral deficiencies.
Potential for Miscalculation: Audits indicate potential for scoring errors with inaccurate data.
Overestimation of Risk: May overestimate risk in certain chronic conditions.

Conclusion

Since its introduction by BAPEN in 2003, the MUST tool has been a cornerstone of effective nutrition diet assessment. Its standardized, five-step process allows for early identification of malnutrition risk, leading to timely intervention and improved patient outcomes. Despite some limitations, MUST remains a crucial and widely used tool for promoting better nutritional health and care for adults.

For more detailed guidance, refer to BAPEN resources.

Frequently Asked Questions

The MUST tool was developed by the Malnutrition Advisory Group, a standing committee of the British Association for Parenteral and Enteral Nutrition (BAPEN).

Following its launch in 2003, MUST gained widespread adoption, and is now the most extensively used nutrition screening tool in the UK across hospitals and care homes.

The five steps are: calculating the BMI score, assessing unintentional weight loss, evaluating the effect of acute disease, combining scores for an overall risk, and developing a management plan.

An overall MUST score of 2 or more indicates a high risk of malnutrition, requiring urgent nutritional intervention and a care plan based on local policy, often involving referral to a dietitian.

Yes, the MUST tool is designed to be used by trained care workers in hospitals, care homes, and community settings to identify adults at risk of malnutrition.

The rescreening frequency depends on the setting: weekly in hospitals, monthly in care homes, and annually for at-risk groups in the community.

No, the MUST tool is not designed to detect specific vitamin or mineral deficiencies or excessive intakes.

Patients with a medium risk score (1) should have their dietary intake monitored over three days. If intake is inadequate, further action should be taken according to local policy.

No, while MUST is widely used, other tools exist, such as the Mini Nutritional Assessment (MNA) for older adults and the Nutrition Risk Screening 2002 (NRS-2002) for hospital patients.