Why Is Malnutrition Screening Important?
Malnutrition is a serious health condition resulting from a deficiency or excess of nutrient intake, or an imbalance of essential nutrients. It can lead to a range of complications, including weakened immune function, poor wound healing, and longer recovery times from illness. Early identification is crucial, which is where malnutrition screening tools come in. These tools are designed to be quick, simple, and effective at identifying individuals who are at risk, allowing healthcare professionals to intervene before the condition worsens.
Various screening tools exist, each with a slightly different focus, target population, and set of questions. Here, we'll examine the specific questions asked on three of the most widely used tools: the Malnutrition Universal Screening Tool (MUST), the Malnutrition Screening Tool (MST), and the Mini Nutritional Assessment-Short Form (MNA-SF).
Questions on the Malnutrition Universal Screening Tool (MUST)
The Malnutrition Universal Screening Tool (MUST) is a five-step process designed for use across multiple care settings, including hospitals, care homes, and the community. The questions and criteria are broken down into three key steps that lead to a final risk score.
Step 1: Body Mass Index (BMI) Score
- What is the patient's BMI ($kg/m^2$)?
- Score 0: BMI > 20 (if over 65, BMI > 22)
- Score 1: BMI 18.5–20 (if over 65, BMI 20–22)
- Score 2: BMI < 18.5 (if over 65, BMI < 20)
Step 2: Weight Loss Score
- Has the patient experienced any unintentional weight loss in the past 3-6 months?
- Score 0: Unintentional weight loss < 5%
- Score 1: Unintentional weight loss 5–10%
- Score 2: Unintentional weight loss > 10%
Step 3: Acute Disease Effect Score
- Is the patient acutely ill and has had, or is likely to have, no nutritional intake for more than 5 days?
- Score 0: No
- Score 2: Yes
These scores are added together to determine the overall risk level. A score of 0 indicates low risk, 1 is medium risk, and 2 or more signifies high risk.
Questions on the Malnutrition Screening Tool (MST)
The Malnutrition Screening Tool (MST) is a simpler, quicker tool, often used for adult hospitalized patients. It focuses on only two questions, making it very user-friendly.
- Have you lost weight recently without trying?
- If yes, how much weight have you lost? The scores are based on the amount of weight lost (in kilograms).
- Have you been eating poorly because of a decreased appetite?
- This is typically a simple 'yes' or 'no' question, with a 'yes' indicating a poor appetite due to eating less than usual.
Questions on the Mini Nutritional Assessment-Short Form (MNA-SF)
The MNA-SF is an abbreviated version of the full Mini Nutritional Assessment and is specifically designed for screening patients 65 years and older. It includes six questions covering a broader range of factors.
- Has food intake declined over the past three months due to loss of appetite, digestive problems, or chewing/swallowing difficulties?
- Scored on a scale from 'no decrease' to 'severe decrease'.
- Weight loss during the last three months?
- Assesses the amount of weight lost, if any, in the last quarter.
- Mobility?
- Questions whether the patient is bedridden, chair-bound, or goes out freely.
- Has the patient suffered psychological stress or acute disease in the past three months?
- Asks if there have been significant stressors, like bereavement, or illness.
- Neuropsychological problems?
- Assesses issues like severe dementia or depression.
- Body Mass Index (BMI) or Calf Circumference (CC)?
- If BMI is unavailable, calf circumference is used as an alternative indicator.
Comparison of Common Malnutrition Screening Tools
| Feature | Malnutrition Universal Screening Tool (MUST) | Malnutrition Screening Tool (MST) | Mini Nutritional Assessment-Short Form (MNA-SF) |
|---|---|---|---|
| Target Population | All adults | Adult hospitalized patients | Elderly (65 years and older) |
| Number of Steps/Questions | 5 steps (3 scoring steps) | 2 questions | 6 questions/criteria |
| Primary Criteria | BMI, unintentional weight loss, acute illness effect | Unintended weight loss, decreased appetite | Food intake, weight loss, mobility, stress/illness, neuropsychology, BMI/CC |
| Equipment Required | Height and weight measurement | None (based on patient recall) | Height, weight, calf measurement, or patient recall |
| Setting | All care settings (community, hospital, care homes) | Hospital setting | Clinics, nursing homes, hospitals |
Interpreting Results and Comprehensive Nutritional Assessment
Screening tools are a first step, not a definitive diagnosis. Based on the score, a patient may be categorized as low, medium, or high risk for malnutrition. A medium or high-risk result necessitates a more detailed nutritional assessment and the development of a care plan.
Next steps for at-risk patients often include:
- Comprehensive Assessment: A thorough evaluation by a registered dietitian, including a detailed clinical and dietary history. This can uncover underlying factors affecting nutritional status, such as difficulty chewing or swallowing, social isolation, or chronic disease.
- Dietary Intervention: Modifying the patient's diet to enhance nutritional intake, which may involve food fortification or oral nutritional supplements.
- Regular Monitoring: Ongoing tracking of weight and nutritional intake to ensure the interventions are effective.
- Managing Underlying Conditions: Addressing medical or psychological issues, like depression or gastrointestinal problems, that may contribute to malnutrition.
Conclusion
Identifying the specific questions on a malnutrition screening tool is the first step towards accurate and timely intervention. Whether using the comprehensive MUST for its objective measurements, the simple MST for a quick hospital check, or the elderly-focused MNA-SF, these tools provide a structured, evidence-based approach to flagging nutritional risk. Understanding the criteria for each helps healthcare providers choose the right tool for their population, ensuring that at-risk individuals receive the detailed nutritional assessment and care they need to improve their health outcomes. For further reading on nutritional assessment, resources from organizations like the National Center for Biotechnology Information (NCBI) are highly authoritative.
