Nutrition Diet: What is the Purpose of a MUST Score?

Malnutrition affects over three million people in the UK, leading to increased complications and healthcare costs. To combat this, the Malnutrition Universal Screening Tool ('MUST') was developed to help healthcare professionals identify, and manage malnutrition risk, answering the vital question: What is the purpose of a MUST score?.

Quick Summary

The Malnutrition Universal Screening Tool (MUST) helps healthcare providers identify adults at risk of malnutrition or obesity using a five-step process. It assesses body mass index (BMI), recent unplanned weight loss, and the effect of acute illness to guide clinical management and inform diet planning.

Key Points

• Screen for Malnutrition: The primary purpose of a MUST score is to systematically screen adults for the risk of malnutrition or obesity across all healthcare settings.

• Inform Care Plans: The score categorizes patients into low, medium, or high-risk groups, which directly guides the appropriate management and care plan.

• Predict Adverse Outcomes: High MUST scores are predictive of worse clinical outcomes, including longer hospital stays, increased complications, and higher mortality rates.

• Standardize Assessment: MUST provides a quick, simple, and standardized method for all care workers to assess nutritional status, ensuring consistency in patient screening.

• Trigger Early Intervention: By facilitating early detection, the MUST score allows for timely nutritional intervention, which can improve patient recovery and overall health.

• Assess Three Parameters: The score is calculated based on three key parameters: Body Mass Index (BMI), recent unplanned weight loss, and the nutritional impact of acute illness.

The Malnutrition Universal Screening Tool, or MUST, is a practical, five-step framework used by healthcare professionals to screen for and manage the risk of malnutrition in adults across various settings. The ultimate goal is to improve patient outcomes by enabling early identification and intervention. Its standardized approach ensures consistent assessment of a patient's nutritional status.

How the MUST Score is Calculated

Calculating a MUST score is a straightforward process completed by care staff. The overall score is the sum of points from three components.

1. Measure BMI Score: Calculate BMI (weight in kg / height in m²) and assign a score: >20 (>30 for obese) scores 0, 18.5-20 scores 1, and <18.5 scores 2.
2. Assess Weight Loss Score: Score unplanned weight loss over 3-6 months: <5% is 0, 5-10% is 1, and >10% is 2.
3. Establish Acute Disease Effect Score: If acutely ill with little to no nutritional intake for >5 days, score 2; otherwise, score 0.
4. Calculate the Total Score: Sum scores from steps 1-3.
5. Develop a Management Plan: Implement a plan based on the total score, e.g., routine monitoring for low risk or dietitian referral for high risk.

Interpreting the MUST Score

The total score categorizes nutritional risk and guides intervention.

• Score 0: Low Risk. Routine care and periodic rescreening.
• Score 1: Medium Risk. Monitor intake; if inadequate, advise on increasing intake.
• Score 2 or More: High Risk. Urgent nutritional support and dietitian referral.

Benefits and Limitations of the MUST Score

The MUST tool offers several benefits, such as simplicity, speed, and enabling early intervention. It has universal applicability and accurately predicts adverse outcomes. However, its limitations include a reliance on proper training, a focus primarily on existing malnutrition rather than development risk, and potential underestimation in certain chronic conditions.

Comparison of Nutritional Screening Tools

The Malnutrition Universal Screening Tool (MUST) focuses on identifying malnutrition risk and obesity in all adults using BMI, unintentional weight loss, and the effect of acute disease. In contrast, the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is more detailed, often used in cancer patients, and includes weight history, food intake, nutritional impact symptoms, and function. The Mini Nutritional Assessment (MNA-SF) is designed for older adults and considers BMI, weight loss, reduced food intake, psychological stress, mobility, and acute disease.

Conclusion: The Role of MUST in Modern Healthcare

Understanding what is the purpose of a MUST score? highlights its critical function as an evidence-based tool for early detection and management of nutritional risk in adults. It helps to prevent negative health outcomes and improve patient recovery. MUST promotes appropriate nutritional care and resource allocation. By using this tool, healthcare providers ensure nutritional concerns are addressed with timely interventions, making MUST a cornerstone of proactive nutritional care.

For more detailed information and resources on using the MUST tool, refer to the British Association for Parenteral and Enteral Nutrition (BAPEN).

Frequently Asked Questions

What does a MUST score of 0 mean?

A MUST score of 0 indicates a low risk of malnutrition. Individuals in this category are typically well-nourished and require routine clinical care, with periodic rescreening as per local policy.

What is the recommended action for a high MUST score?

A high MUST score (2 or more) signals a high risk of malnutrition. The recommended action is an immediate referral to a dietitian or a nutritional support team for a comprehensive assessment and development of a personalized care plan.

Who can use the Malnutrition Universal Screening Tool?

The tool is designed for use by a wide range of healthcare professionals and care workers in various settings, including nurses, dietitians, and other allied health professionals.

Does the MUST score screen for vitamin deficiencies?

No, the MUST score is not designed to detect deficiencies or excessive intakes of specific vitamins and minerals. It focuses on overall nutritional status related to BMI, weight loss, and acute illness.

What is considered a significant 'unplanned weight loss' in the MUST score?

Unplanned weight loss of 5-10% in the past 3-6 months results in a score of 1, while a weight loss of more than 10% is scored as 2. These thresholds help determine the severity of risk.

Can the MUST score be used in all patient populations?

The MUST score is validated for adult populations, including the elderly. However, it is not intended for use with pediatric or pregnant patients, who require different assessment tools.

How often should patients be rescreened with the MUST tool?

The rescreening frequency depends on the patient's risk category and care setting. High-risk patients typically have their care plan reviewed weekly, medium-risk patients are monitored regularly, and low-risk patients are rescreened at longer intervals.