Understanding the Malnutrition Universal Screening Tool (MUST)
The Malnutrition Universal Screening Tool (MUST) is a five-step screening tool developed by the British Association for Parenteral and Enteral Nutrition (BAPEN). It's used to identify adults who are malnourished, at risk of malnutrition, or obese across various healthcare settings. The tool provides a systematic approach to screening and guides management to improve patient outcomes.
How the MUST Score is Calculated
The MUST score is calculated by summing scores from three components: Body Mass Index (BMI), unintentional weight loss, and the effect of acute disease. Each component contributes a score of 0, 1, or 2.
- Body Mass Index (BMI) Score: Based on height and weight. BMI <18.5 scores 2, 18.5–20 scores 1, and >20 (>30 for obese) scores 0.
- Weight Loss Score: Assesses unintentional weight loss over 3-6 months. >10% scores 2, 5–10% scores 1, and <5% scores 0.
- Acute Disease Effect Score: Scores 2 if the patient is acutely ill and has had, or is likely to have, no nutritional intake for over 5 days.
What a High MUST Score Indicates
A high MUST score (≥2) indicates a high risk of malnutrition, requiring a comprehensive nutritional assessment rather than being a diagnosis itself. High scores are associated with increased morbidity, longer hospital stays, higher readmission rates, and increased mortality.
Management and Care for High-Risk Individuals
Identifying a high MUST score requires immediate action and a coordinated care plan to improve nutritional status and overall health.
The Care Plan for a High MUST Score
- Referral to a specialist: High-risk patients need immediate referral to a dietitian or nutritional support team for detailed assessment and intervention.
- Comprehensive assessment: Specialists evaluate dietary intake, appetite, food preferences, and underlying medical/social factors affecting nutrition.
- Initiating nutritional support: Based on the assessment, support may include food fortification, oral nutritional supplements (ONS), or enteral/parenteral nutrition.
- Regular monitoring: Weight, dietary intake, and nutritional status are monitored closely to track progress and adjust the plan. Weekly monitoring is common in hospitals.
- Treating underlying conditions: Addressing the root cause, such as illness or difficulty accessing food, is a priority.
High Risk vs. Other Scores
The MUST tool's scoring helps prioritize care.
| Risk Level | MUST Score | Primary Action | Management Details |
|---|---|---|---|
| Low Risk | 0 | Routine Clinical Care | Rescreen annually (community), monthly (care homes), weekly (hospitals). |
| Medium Risk | 1 | Observe and Monitor | Document intake (3 days). If inadequate, provide dietary advice and consider supplements. Rescreen monthly. |
| High Risk | ≥2 | Refer to Specialist | Immediate referral to dietitian/nutritional team. Implement intensive support, monitor regularly. |
What Contributes to a High MUST Score?
A high score can result from a combination of factors, such as low BMI and significant weight loss. Acute illness can further increase the score. The tool effectively identifies these cumulative risks. It also notes obesity in those with high scores due to acute illness or weight loss, recognizing conditions like sarcopenic obesity.
The Importance of the MUST Tool
Early identification of nutritional risk through tools like MUST is crucial for timely intervention and improved health outcomes. It helps prevent malnutrition from going unrecognized, especially in vulnerable populations. Early support enhances recovery, boosts the immune system, and improves quality of life. Further resources on the MUST tool are available on the BAPEN website BAPEN.
Conclusion
A high MUST score signals a significant risk of malnutrition, providing a rapid risk assessment based on BMI, unintentional weight loss, and acute disease effect. It prompts specific actions, including specialist referral and a comprehensive nutritional care plan, leading to targeted intervention and better health outcomes for patients.
