The Malnutrition Universal Screening Tool (MUST) is a widely used and validated five-step tool designed to identify adults at risk of malnutrition or who are obese. Developed by BAPEN, it is utilized across various healthcare settings. MUST offers a systematic method for assessing nutritional status, helping healthcare professionals quickly determine a patient's risk level and create a suitable care plan. The initial step in this process is a critical measurement.
What is step 1 of must? The BMI score
The first step of the MUST assessment involves determining a patient's Body Mass Index (BMI) and assigning a score. BMI is a straightforward measure using height and weight to estimate body fat. For more detailed information on BMI calculation and scoring within MUST, refer to {Link: Geeky Medics https://geekymedics.com/malnutrition-universal-screening-tool-must-osce-guide/}. Accurate height and weight measurements are typically obtained using clinical scales and a height measure. However, MUST provides alternative methods if direct measurement isn't possible.
How to measure height and weight for an accurate BMI
Accurate measurement is vital for a correct BMI score. For height, the patient should stand upright against a stadiometer or measure. Weight is taken with the patient in light clothing, without shoes, on zeroed scales. Patient consent and clear communication are necessary.
Alternative measurements when direct BMI is not possible
If direct measurement is not feasible due to immobility or other clinical factors, alternative methods can estimate the BMI category. Mid-upper arm circumference (MUAC) is one method to estimate weight status. Reliable reported or previous weight and height data can also be used. For patients with conditions like amputations or significant fluid retention (oedema/ascites), clinical judgment or alternative measures are crucial as standard BMI would be inaccurate.
The remaining steps of the MUST assessment
Step 1 provides an initial assessment, but the subsequent steps complete the nutritional screening by considering weight history and acute illness.
Step 2: Unplanned weight loss score
Step 2 evaluates recent unplanned weight loss. A score is assigned based on the percentage of weight lost over 3–6 months. For example, 5–10% loss scores 1, and over 10% scores 2. This requires comparing current weight to a reliable previous weight.
Step 3: Acute disease effect score
This step addresses the nutritional impact of acute illness. For details on scoring related to acute illness, see {Link: Geeky Medics https://geekymedics.com/malnutrition-universal-screening-tool-must-osce-guide/}. If no such illness is present, the score is 0.
Step 4: Overall risk score
Step 4 combines the scores from the first three steps to determine the overall malnutrition risk. The total score categorizes the patient into:
- Score 0: Low risk
- Score 1: Medium risk
- Score 2 or more: High risk
Step 5: Management guidelines
The final step offers guidance based on the overall risk score. Low-risk patients receive routine care and re-screening. Medium-risk patients require dietary intake monitoring and follow-up if intake is insufficient. High-risk patients need immediate action, often including referral to a dietitian or nutritional support team.
Comparison of measurement methods for MUST
| Feature | Standard Method | Alternative Methods (e.g., MUAC) |
|---|---|---|
| Equipment | Weighing scales, height measure (stadiometer) | Tape measure, MUAC tape |
| Patient Condition | Ambulatory and able to stand | Immobile, amputations, fluid retention |
| Accuracy | Generally very accurate | Less precise, provides an estimate of BMI category |
| Calculation | Direct calculation ($$kg/m^2$$) | Requires conversion charts or clinical judgment |
| Time/Effort | Quick and efficient for mobile patients | May take slightly longer and requires additional knowledge |
| Considerations | Requires patient cooperation and mobility | Should be noted in documentation and used with clinical judgment |
The importance of nutrition diet in clinical settings
Utilizing tools like MUST is crucial for positive health outcomes. Malnutrition increases complications and prolongs hospital stays. Screening with MUST helps ensure patients receive appropriate nutritional support, including a tailored nutrition diet. MUST has been shown to predict outcomes like postoperative declines. BAPEN provides resources on nutritional care.
Conclusion: The foundation of nutritional care
Step 1 of MUST is a vital starting point for comprehensive nutritional assessment. Accurate BMI measurement allows healthcare professionals to begin identifying and managing malnutrition risk. This foundational step is crucial for developing targeted nutrition diet plans and improving patient outcomes. More information on the MUST tool can be found on {Link: Geeky Medics https://geekymedics.com/malnutrition-universal-screening-tool-must-osce-guide/}.
