Malnutrition Universal Screening Tool (MUST)
The Malnutrition Universal Screening Tool (MUST) is a widely used five-step screening tool for adults in various care settings. Developed by the British Association for Parenteral and Enteral Nutrition (BAPEN), it is designed to identify adults who are malnourished, at risk of malnutrition, or obese. The systematic process helps healthcare professionals determine a patient's overall risk score, which then guides appropriate care and intervention.
The Five Steps of MUST
- Body Mass Index (BMI) Score: The first step involves calculating the patient's BMI to assign a score. For instance, a BMI below 18.5 kg/m² scores 2, while a BMI of 20 kg/m² or higher scores 0.
- Weight Loss Score: This step assesses recent unplanned weight loss. A score is given based on the percentage of weight lost over the past 3 to 6 months.
- Acute Disease Effect Score: An additional score is added if the patient is acutely ill and has had, or is likely to have, no nutritional intake for more than five days.
- Combining Scores: The scores from the first three steps are added together to determine the patient's overall risk of malnutrition.
- Management Guidance: Based on the overall score (low, medium, or high risk), management guidelines are provided to develop an appropriate care plan.
Mini Nutritional Assessment (MNA®)
The Mini Nutritional Assessment (MNA®) is a validated screening and assessment tool specifically for geriatric patients aged 65 and over. It helps identify elderly individuals who are either already malnourished or at risk. The MNA has evolved over time into a shorter, more streamlined version (the MNA®-SF), consisting of just six questions, making it quick and easy for clinical use. The tool assesses factors such as dietary intake, recent weight loss, mobility, psychological stress, and BMI. A specific score determines if a patient is well-nourished, at risk of malnutrition, or malnourished, guiding further intervention.
Mid-Upper Arm Circumference (MUAC)
Mid-Upper Arm Circumference (MUAC) is a rapid and effective screening method that measures the circumference of a patient's upper arm. It is particularly valuable for children aged 6 to 59 months and in settings where weighing scales are unavailable. A color-coded MUAC tape is used for quick interpretation: green indicates normal status, yellow suggests moderate malnutrition risk, and red signifies severe acute malnutrition. MUAC can also be used in adults, with specific cut-off points to indicate risk levels.
Comprehensive Assessment vs. Screening
While screening tools like MUST, MNA®, and MUAC are excellent for quick risk identification, a comprehensive nutritional assessment provides a deeper, more detailed evaluation. A full assessment is conducted by healthcare providers for patients identified as at-risk during screening and involves a multi-faceted approach.
Comparison Table: Screening vs. Comprehensive Assessment
| Feature | Nutritional Screening | Comprehensive Nutritional Assessment |
|---|---|---|
| Purpose | Quickly identify individuals at risk of malnutrition. | Systematically evaluate overall nutritional status and diagnose specific conditions. |
| Tools | MUST, MNA®, MUAC tapes, etc.. | Combination of clinical history, physical exam, anthropometry, and lab tests. |
| Duration | Quick, often taking only a few minutes. | More time-consuming and in-depth. |
| Users | Can be performed by a wider range of healthcare staff. | Conducted by trained clinicians, dietitians, and physicians. |
| Outcome | Risk classification (low, medium, high). | Diagnostic report, including specific deficiencies and underlying causes. |
Other Relevant Tools and Methods
- Subjective Global Assessment (SGA): This is a clinical technique that evaluates the patient's history of weight loss, dietary intake, gastrointestinal symptoms, and functional capacity to classify their nutritional status. It also includes a physical examination to assess for fat and muscle wasting.
- Dietary Assessment: Methods like 24-hour recalls, food frequency questionnaires, and food diaries are used to gather detailed information about a patient's eating habits and nutrient intake. This helps identify specific dietary deficiencies or excesses.
- Biochemical Analysis: Laboratory tests are a critical component of a comprehensive assessment. They include analyzing serum protein levels (e.g., albumin, prealbumin), micronutrient levels (e.g., iron, B12, vitamin D), and other blood markers to pinpoint specific deficiencies.
- Growth Charts: For infants and children, growth charts are an essential tool for monitoring nutritional status over time. They help identify patterns of poor growth, such as stunting (low height-for-age) and wasting (low weight-for-height), which are key indicators of malnutrition.
Conclusion
The tool used to assess malnutrition depends heavily on the population being evaluated and the setting in which the assessment takes place. For quick screening in adults, the MUST tool is highly effective, while the MNA® is specifically designed for the elderly. For a rapid assessment of severe acute malnutrition, particularly in children, MUAC is a critical tool. However, for a definitive diagnosis and comprehensive care plan, a combination of screening, clinical history, anthropometric measurements, and biochemical analysis is necessary. The selection of the right tool is a crucial first step in a broader, systematic approach to addressing malnutrition and improving overall health outcomes. For further reading, resources are available from organizations like BAPEN on effective screening practices.
