What is a Malnutrition Score of 1?
A malnutrition score of 1 typically indicates a medium risk of malnutrition, as defined by widely used clinical tools, most notably the Malnutrition Universal Screening Tool (MUST). MUST is a five-step screening process developed by the British Association for Parenteral and Enteral Nutrition (BAPEN) to identify adults who are malnourished, at risk of malnutrition, or obese. A total MUST score of 1 is a yellow flag, signaling that while the nutritional risk is not immediately severe, it requires observation, monitoring, and proactive dietary intervention to prevent further decline.
The Components That Lead to a MUST Score of 1
The MUST assessment is based on a scoring system derived from three primary components, with a final total score dictating the level of risk. A score of 1 can be achieved in a few different ways, which is crucial for understanding the root cause of the medium risk classification.
BMI (Body Mass Index) Score
The first step in the MUST assessment evaluates the patient's BMI. A score is assigned based on the BMI calculation ($weight(kg) / height(m)^2$). A score of 1 is given for a BMI in the 18.5–20 kg/m² range, which is considered borderline or slightly underweight. This is distinct from a high-risk score of 2 (BMI less than 18.5 kg/m²) or a low-risk score of 0 (BMI greater than 20 kg/m²).
Weight Loss Score
Step two assesses unintentional weight loss over the previous 3 to 6 months. This is a critical indicator of recent nutritional decline. A score of 1 is assigned if the patient has experienced an unplanned weight loss of 5–10% of their body weight. A more significant loss (over 10%) would result in a high-risk score of 2, while less than 5% is a low-risk score of 0.
Acute Disease Effect Score
The final component, step three, considers the impact of an acute illness on nutritional intake. If a patient is acutely ill and has had or is likely to have no nutritional intake for more than five days, a score of 2 is given. If no such acute illness is present, the score is 0. A score of 1 from this component is not possible, meaning a total score of 1 must be a combination of BMI and/or weight loss scores.
Clinical Management of a Malnutrition Score of 1
Upon receiving a MUST score of 1, the recommended management guidelines shift from routine care to active observation and intervention. This phase is designed to stabilize the patient's nutritional status and reverse the risk before it escalates. The care plan includes several key actions:
- Dietary Documentation: Healthcare professionals will typically document dietary intake over a period of three days to assess if the intake is adequate.
- Initial Dietary Advice: If intake is found to be inadequate, first-line dietary advice is provided, often referred to as 'Food First'. This focuses on enriching the diet with nutrient-dense foods.
- Diet Fortification: The plan may involve providing a diet fortified with high-calorie and high-protein foods, along with two nourishing snacks per day between meals.
- Nutritious Drinks: Offering nourishing drinks like milk or fruit juice throughout the day is also recommended.
- Monitoring and Review: The patient's weight and food intake are monitored regularly, and the screening process is repeated monthly or more frequently based on clinical need.
Comparison of MUST Risk Categories
| Feature | Score 0 (Low Risk) | Score 1 (Medium Risk) | Score 2+ (High Risk) |
|---|---|---|---|
| Overall Risk | Low risk of malnutrition. | Medium risk of malnutrition. | High risk of malnutrition. |
| BMI | BMI > 20 kg/m² (or > 30 for obese). | BMI between 18.5–20 kg/m². | BMI < 18.5 kg/m². |
| Unplanned Weight Loss | Unplanned weight loss < 5%. | Unplanned weight loss of 5–10%. | Unplanned weight loss > 10%. |
| Acute Disease Effect | Not acutely ill, no expected nil by mouth for >5 days. | Can contribute to a score of 1 via BMI or weight loss scores. | Acutely ill, with no or little nutritional intake for >5 days (adds 2 points). |
| Management | Routine clinical care; repeat screening periodically. | Observe and provide dietary advice; monitor food intake and weight. | Refer to a dietitian or specialist team; intensive nutritional support. |
Preventing the Progression of Malnutrition
Early detection, signaled by a score of 1, is a crucial step toward preventing more severe malnutrition. For individuals identified as medium risk, several strategies can help improve nutritional status:
- Optimize Nutrient Intake: Focus on incorporating a variety of nutrient-rich foods into the diet. This includes lean proteins, whole grains, fruits, and vegetables.
- Fortified Foods and Drinks: For those with a poor appetite, fortifying foods (e.g., adding milk powder to soups) and using oral nutritional supplements (ONS) can help increase calorie and protein intake.
- Regular Physical Activity: Engaging in regular exercise helps to maintain and build muscle mass, which is often depleted during malnutrition.
- Address Underlying Issues: It is important to investigate and address any medical or psychosocial issues that might be contributing to poor nutritional intake. These can include medical conditions, difficulty chewing or swallowing, or depression.
- Consult a Professional: A registered dietitian can provide personalized guidance and a structured nutrition care plan to manage the risk and support overall dietary needs.
Conclusion
In the context of standardized screening, understanding what is a malnutrition score of 1 is the first step towards effective nutritional intervention. It signifies a medium level of risk that requires active observation and dietary management, rather than waiting for nutritional status to deteriorate further. By implementing a focused nutrition care plan that includes dietary advice, monitoring, and addressing potential underlying issues, it is possible to reverse this risk and improve overall health and wellbeing. Early intervention and consistent follow-up are critical for preventing the progression to high-risk malnutrition and associated adverse health outcomes. More information about the MUST tool and managing malnutrition can be found through resources like the British Association for Parenteral and Enteral Nutrition (BAPEN).
