What is the MUST Questionnaire for Nutrition?
The Malnutrition Universal Screening Tool, or MUST, is a widely used five-step tool for screening adults for malnutrition, risk of malnutrition, or obesity. Developed by the British Association for Parenteral and Enteral Nutrition (BAPEN), MUST provides a standard method for assessing nutritional status in various settings like hospitals, community care, and care homes. Its primary aim is early identification and intervention to improve patient outcomes and lower healthcare costs.
The Five Steps of the MUST Screening Process
Performing a MUST assessment involves following a clear, five-step process.
Step 1: Calculate the Body Mass Index (BMI) Score
The first step is to measure or calculate the patient's BMI. The BMI value is then given a score:
- Score 0: BMI $\ge$ 20 kg/m² ($\ge$ 30 kg/m² for obese)
- Score 1: BMI 18.5–20 kg/m²
- Score 2: BMI < 18.5 kg/m²
Step 2: Determine the Unplanned Weight Loss Score
This step evaluates the percentage of unintentional weight loss over the past 3–6 months.
- Score 0: Unplanned weight loss < 5%
- Score 1: Unplanned weight loss 5–10%
- Score 2: Unplanned weight loss > 10%
Step 3: Assess the Acute Disease Effect Score
An acutely ill patient with minimal or no nutritional intake expected for over 5 days is at increased nutritional risk. The scoring is:
- Score 0: Not acutely ill, or has had nutritional intake for more than 5 days.
- Score 2: Acutely ill, with little to no nutritional intake for over 5 days.
Step 4: Calculate the Overall Risk Score
Adding the scores from the first three steps determines the patient's overall malnutrition risk category, guiding subsequent actions.
- Low Risk: Total score of 0
- Medium Risk: Total score of 1
- High Risk: Total score of 2 or more
Step 5: Implement Management Guidelines
Based on the overall risk score, specific management guidelines are recommended to develop a care plan.
- Low Risk: Routine clinical care with rescreening at regular intervals (e.g., annually in the community, weekly in hospital).
- Medium Risk: Document dietary intake; if inadequate, initiate nutritional support and monitor closely.
- High Risk: Refer to a dietitian or nutrition support team for comprehensive assessment and a tailored nutrition care plan, with regular monitoring.
Comparison of MUST with Other Nutritional Screening Tools
The choice of nutritional screening tool depends on the clinical context. Other tools include NRS-2002 and PG-SGA SF. For a comparison table, please see the {Link: Fiveable Study Guide https://fiveable.me/nutrition-assessment/unit-8/malnutrition-universal-screening-tool-must/study-guide/krxaJvizFbRY2lKX}.
Alternative Measurements for MUST
When standard height and weight measurements are not feasible, MUST offers alternative methods like mid-upper arm circumference (MUAC) or ulna length to estimate BMI.
Conclusion
The Malnutrition Universal Screening Tool (MUST) is essential for nutritional screening in adults across different care environments. Its structured, five-step process provides a reliable way to identify individuals at risk. By enabling early intervention through clear guidelines, MUST helps healthcare professionals improve patient outcomes and quality of care. More details can be found in the official {Link: BAPEN guidelines https://www.bapen.org.uk/pdfs/must/must_full.pdf}.
BAPEN's Role in MUST Development
BAPEN developed and maintains the MUST tool for nutritional screening.
Flexibility in MUST Screening
When objective measurements are difficult, MUST allows for subjective clinical judgment or alternative measurements like MUAC.
Rescreening Frequency
Rescreening frequency depends on risk and setting; high-risk patients need more frequent monitoring.
Predicting Patient Outcomes
High MUST scores predict worse outcomes, including longer hospital stays and higher mortality.
MUST and Specific Patient Groups
Special interpretation of MUST is needed for groups like those with fluid issues or amputations.
Comprehensive Nutritional Assessment
A comprehensive assessment by a dietitian is recommended for medium or high-risk patients.
MUST is not a Diagnostic Tool
MUST is a screening tool to identify risk, not a diagnostic tool for malnutrition.
