The Malnutrition Universal Screening Tool (MUST) is a widely used and validated five-step tool for healthcare professionals. Its purpose is to identify adults who are malnourished, at risk of malnutrition, or obese, enabling the creation of appropriate care plans. This comprehensive yet straightforward method is applicable in a variety of settings, including hospitals, care homes, and community care. Understanding each step is crucial for accurate assessment and effective intervention.
The Five Steps of the MUST Screening Tool
Step 1: Calculate the Body Mass Index (BMI) Score
The first step in the MUST screening process is to determine the patient's BMI and assign a corresponding score. The BMI calculation is done by dividing the patient's weight in kilograms by the square of their height in meters. For patients who are unable to be measured, alternative measurements or estimations can be used.
- BMI over 20 (>30 for obese): Scores 0
- BMI between 18.5 and 20: Scores 1
- BMI under 18.5: Scores 2
Step 2: Note the Percentage of Unplanned Weight Loss
Next, the tool requires assessing any unplanned or unintentional weight loss that has occurred over the past three to six months. This can be determined by asking the patient or a caregiver, or by consulting recent medical records for weight measurements. The score is assigned based on the percentage of weight lost.
- Unplanned weight loss less than 5%: Scores 0
- Unplanned weight loss between 5-10%: Scores 1
- Unplanned weight loss over 10%: Scores 2
Step 3: Establish the Acute Disease Effect Score
This step accounts for the increased nutritional risk associated with acute illness. A score of 2 is assigned if the patient is acutely ill and has had, or is likely to have, no nutritional intake for more than five days. If this condition does not apply, the score for this step is 0.
Step 4: Add the Scores to Determine Overall Risk
The scores from the first three steps are combined to give an overall MUST score, which indicates the patient's risk category.
- Score of 0: Low Risk of Malnutrition
- Score of 1: Medium Risk of Malnutrition
- Score of 2 or more: High Risk of Malnutrition
Step 5: Develop a Care Plan Based on Management Guidelines
The final step involves using the risk category to guide the next course of action. The MUST guidelines provide clear instructions for management, which can be adapted based on local policy and the patient's specific needs. This can involve anything from repeat screening to referral for specialist nutritional support.
Detailed Management Guidelines
- Low-Risk Patients (Score 0): No immediate action is required beyond routine clinical care. The patient should be re-screened regularly, with the frequency depending on the care setting (e.g., weekly in hospitals, monthly in care homes, every 2-3 months in the community).
- Medium-Risk Patients (Score 1): The patient's dietary intake should be documented for three days. If intake is inadequate, nutritional intake should be improved, for instance, through food fortification or snacks. A care plan should be developed and monitored regularly.
- High-Risk Patients (Score 2 or more): This group requires more intensive intervention. The patient should be referred to a dietitian or nutritional support team. A specific, detailed care plan should be developed, implemented, and closely monitored and reviewed, with treatment of underlying conditions as necessary.
MUST vs. Other Nutritional Screening Tools
| Feature | Malnutrition Universal Screening Tool (MUST) | Nutrition Risk Screening 2002 (NRS-2002) | Mini Nutritional Assessment (MNA) | Subjective Global Assessment (SGA) |
|---|---|---|---|---|
| Primary Purpose | Identify adults at risk of malnutrition or obesity. | Identify hospital patients at nutritional risk. | Assess nutritional status in the elderly. | Assess nutritional status based on patient history and physical exam. |
| Target Population | Adults across all care settings (hospital, community, care homes). | Hospitalized adults. | Adults over 65 years of age. | Any hospitalized or community patient. |
| Key Parameters | BMI, unintentional weight loss, acute disease effect. | BMI, weight loss, appetite, severity of disease. | Dietary intake, mobility, weight loss, BMI, psychological stress. | Weight change, dietary intake change, GI symptoms, functional capacity, physical signs. |
| Ease of Use | Simple, requiring basic measurements and information. | Quick initial screen, followed by a more detailed assessment. | Self-administered version available, focuses on the elderly. | Relies on clinical judgment and patient interview. |
| Outcome | Risk category (Low, Medium, High) with management guidelines. | Risk score requiring a more comprehensive assessment if high. | Total score indicates nutritional status (normal, risk, malnourished). | Categorizes patients as well nourished, moderately malnourished, or severely malnourished. |
Conclusion
The Malnutrition Universal Screening Tool (MUST) provides a structured, five-step framework for effectively identifying individuals at risk of malnutrition and obesity. By systematically evaluating a patient’s BMI, recent unplanned weight loss, and the impact of acute illness, healthcare professionals can quickly and accurately determine a risk category. This information is then used to implement standardized, evidence-based management plans, ensuring that patients receive the nutritional care they need. The tool's wide applicability across different care settings makes it an invaluable asset in clinical practice, helping to improve patient outcomes related to nutritional health.
For more detailed information, the British Association for Parenteral and Enteral Nutrition (BAPEN) provides a comprehensive guide to the MUST tool.
