What is the Malnutrition Universal Screening Tool (MUST)?
MUST is an acronym for the Malnutrition Universal Screening Tool, a valuable five-step system designed to help healthcare professionals and trained caregivers screen for, identify, and manage malnutrition in adult patients. Developed by the British Association for Parenteral and Enteral Nutrition (BAPEN), MUST provides a structured approach for use across various settings, including hospitals, community care, and care homes. Its design allows for the early detection of nutritional risk, which is crucial for improving patient outcomes and reducing the burden on healthcare services. The tool assesses three main components to generate an overall risk score and corresponding management plan.
The Five Steps of the MUST Tool
The MUST assessment is a straightforward, five-step process that can be completed efficiently to determine a patient's risk category.
- Calculate the BMI Score: The first step involves measuring the patient's height and weight to calculate their Body Mass Index ($BMI = ext{weight (kg)} / ext{height (m)}^2$). The BMI score is assigned based on the result: a BMI of >20 ($>30$ obese) scores 0, a BMI between 18.5–20 scores 1, and a BMI of <18.5 scores 2. Alternative measurements, such as mid-upper arm circumference (MUAC) or ulna length, can be used if height and weight cannot be reliably measured.
- Determine the Weight Loss Score: The second step focuses on assessing recent unplanned weight loss. The percentage of unintentional weight loss over the past three to six months is calculated. A weight loss of <5% scores 0, 5-10% scores 1, and >10% scores 2. This can be determined from medical records or by asking the patient or their caregiver.
- Establish the Acute Disease Effect Score: The third step assesses the impact of acute illness on nutritional intake. If a patient is acutely ill (e.g., critical illness, surgery, swallowing difficulties) and has had, or is likely to have, no nutritional intake for more than five days, a score of 2 is assigned. If not, the score is 0.
- Calculate the Overall Risk Score: The scores from the first three steps are added together to produce an overall MUST score, which ranges from 0 to 6.
- Develop the Management Plan: The final step is to use the overall risk score to inform a management plan based on the patient's risk category (low, medium, or high). The plan may include routine care, observation, or referral to a specialist.
Understanding the MUST Score and Management
The numerical score from the MUST assessment corresponds to a specific risk category, which in turn guides the appropriate management strategy. A low score indicates low risk, a medium score indicates medium risk, and a high score indicates high risk.
| Score | Risk Category | Management Guidelines |
|---|---|---|
| 0 | Low Risk | Routine Clinical Care: Repeat screening at defined intervals (e.g., annually in the community, weekly in hospitals). No specific nutritional intervention is required beyond general health eating advice. |
| 1 | Medium Risk | Observe and Monitor: Document dietary intake for three days. If intake is adequate, continue with routine care. If intake is inadequate or there are concerns, follow local policy to improve nutritional intake and monitor regularly. Consideration should be given to high-energy, high-protein foods or drinks. |
| 2 or more | High Risk | Referral for Support: Refer the patient to a dietitian or nutrition support team for a comprehensive assessment and a tailored nutritional care plan. This plan may include oral nutritional supplements, fortified diets, or more intensive interventions. |
The Importance of the MUST Tool in Healthcare
The MUST tool has significant implications for patient care and health outcomes. Its widespread adoption is due to its simplicity, speed, and reliability across different healthcare environments. By providing a standardized approach, it helps prevent malnutrition from being missed or undertreated, which is a common problem. Early and accurate screening using MUST allows for timely intervention, which can lead to better recovery rates, fewer complications, and shorter hospital stays. The tool is not intended to replace clinical judgment but to inform and support it, ensuring that nutritional health is proactively managed. In cases where a patient's physical measurements are unreliable, a subjective clinical impression can be used to inform the risk category.
It is important to remember that MUST is just one part of a comprehensive care strategy. While it effectively screens for malnutrition risk based on BMI, weight loss, and acute illness, it is not designed to detect specific vitamin or mineral deficiencies. Healthcare professionals must use their clinical expertise to interpret the results and formulate the most appropriate care plan for each individual.
Additional Considerations and Patient Groups
The MUST tool, while highly effective for most adults, has specific considerations for certain patient populations, such as those with fluid disturbances, amputations, or critical illnesses. The tool's explanatory booklet, available from BAPEN, offers detailed guidance on these specific cases. The importance of regular rescreening cannot be overstated, as a patient's nutritional risk can change over time, especially during or after illness. The frequency of rescreening varies by setting, highlighting the need for consistent monitoring in all care environments.
Conclusion
The phrase "MUST malnutrition" refers to the Malnutrition Universal Screening Tool, a critical instrument for identifying and managing nutritional risk in adults. By systematically assessing BMI, weight loss, and the impact of acute disease, MUST empowers healthcare providers to categorize patients into low, medium, or high-risk groups. This structured approach facilitates targeted interventions, from routine monitoring to specialized nutritional support, which is essential for improving patient outcomes. The widespread adoption of MUST underscores its value in standardizing nutritional screening and ensuring that malnutrition is identified and addressed promptly and effectively. For further resources and detailed guidance, healthcare professionals can consult the official BAPEN website at BAPEN.
A List of the Five MUST Assessment Steps
- Step 1: Measure height and weight to determine BMI and its corresponding score.
- Step 2: Note unplanned weight loss percentage and assign a score.
- Step 3: Assess the acute disease effect on nutritional intake to determine the final score component.
- Step 4: Sum the scores from the previous steps to obtain the overall risk category.
- Step 5: Use the risk category to develop and implement a management care plan.
Management Examples Based on MUST Score
- Low Risk (Score 0): Monitor weekly in a hospital setting, monthly in a care home, or annually in the community. Continue routine clinical care and provide basic healthy eating advice.
- Medium Risk (Score 1): Observe dietary intake for three days. If intake is inadequate, consider implementing a fortified diet with high-energy snacks and nourishing drinks. Monitor and review the plan regularly.
- High Risk (Score 2 or more): Refer to a dietitian or nutritional support team for a comprehensive assessment. Develop an individualized care plan, which may involve specialized support like oral nutritional supplements or tube feeding. Monitor nutritional status and intervention effectiveness closely.
