Malnutrition, a state resulting from a deficiency or excess of nutrient intake, can significantly impact health outcomes. Identifying individuals at risk or already experiencing malnutrition is important for timely intervention and improved well-being. The Malnutrition Universal Screening Tool (MUST) provides a systematic and widely adopted method for assessing nutritional status in adults.
Understanding the Malnutrition Universal Screening Tool (MUST)
The Malnutrition Universal Screening Tool (MUST) is a five-step screening tool designed to identify adults who are malnourished, at risk of malnutrition, or obese. It enables early identification and intervention for nutritional issues across healthcare settings. The tool is for use by all care workers, including nurses, dietitians, and other healthcare professionals. MUST’s systematic approach helps standardize nutritional screening for consistent patient assessment.
How to Use the MUST Tool: The Assessment Steps
The first step involves determining Body Mass Index (BMI). BMI is calculated by dividing weight in kilograms by the square of height in meters. A BMI less than 18.5 kg/m² scores 2 points, 18.5 to 20 kg/m² scores 1 point, and a BMI greater than 20 kg/m² scores 0 points.
The second component assesses unintentional weight loss over the past 3 to 6 months. This requires asking about recent weight changes without intentional dietary changes. A weight loss greater than 10% scores 2 points, 5-10% scores 1 point, and less than 5% scores 0 points.
The third step evaluates the effect of an acute disease, defined as no nutritional intake for more than five days. This applies to acutely ill individuals with little or no food intake for this duration. If present, a score of 2 points is assigned, regardless of BMI or recent weight loss.
Interpreting MUST Scores and Guiding Care
After completing the first three assessment steps, individual scores are added to determine an overall malnutrition risk. A total score of 0 indicates low risk, suggesting routine clinical care and monitoring. Re-screening is recommended annually for community settings and weekly for hospital patients.
A total score of 1 indicates medium risk, prompting observation and a basic care plan. This involves documenting dietary intake for three days and providing nutritional advice. Re-screening is advised weekly for hospital patients and monthly for community settings.
A total score of 2 or more signifies high risk, necessitating a comprehensive nutritional care plan. This often includes referral to a dietitian or nutritional support team, and may involve dietary fortification, nutritional supplements, or artificial nutrition methods.
Important Considerations for Accurate Screening
Applying the MUST tool requires careful consideration in specific patient populations for accurate assessments. For individuals with fluid disturbances, such as edema or ascites, measured weight may be artificially elevated. A “dry weight” estimation or adjusting BMI and weight loss interpretation is important.
Patients with amputations challenge standard BMI calculations, as the missing limb affects total body weight. Adjustments to body weight or height for the missing limb are necessary for a more accurate BMI, or alternative assessment methods may be considered.
In critical illness, patients often experience rapid physiological changes, making accurate weight and dietary intake assessment difficult. Clinical judgment is important, and the “acute disease effect” score of 2 points is often applied, reflecting the severe impact of illness on nutritional status.
Understanding the Malnutrition Universal Screening Tool (MUST)
The Malnutrition Universal Screening Tool (MUST) is a five-step screening tool developed to identify adults who are malnourished, at risk, or obese. Its objective is early detection and management of nutritional issues across healthcare environments. The tool is for use by all care workers, including nurses and other healthcare professionals, ensuring a consistent approach to nutritional screening.
How to Use the MUST Tool: The Assessment Steps
The first step in applying the MUST tool involves determining Body Mass Index (BMI). BMI is calculated by dividing weight in kilograms by the square of height in meters. A score of 2 points is assigned for a BMI less than 18.5 kg/m², 1 point for 18.5 to 20 kg/m², and 0 points for a BMI greater than 20 kg/m².
The second component assesses unintentional weight loss over the past three to six months. This involves inquiring about significant weight changes without intentional dietary efforts. If an individual has lost more than 10% of their body weight, 2 points are scored; a loss of 5-10% scores 1 point; and less than 5% scores 0 points.
The third step evaluates the effect of acute disease, specifically if there has been no nutritional intake for five days or more. This applies to acutely unwell individuals who have had, or are likely to have, little or no food intake for this duration. If this condition is present, a score of 2 points is assigned, regardless of BMI or recent weight loss.
Interpreting MUST Scores and Guiding Care
The individual scores from the assessment steps are combined to determine an overall malnutrition risk. A total score of 0 indicates low risk, suggesting routine clinical care and monitoring. Re-screening is generally recommended annually in community settings and weekly for hospital patients.
A total score of 1 indicates medium risk, prompting observation and a basic care plan. This involves documenting dietary intake for three days and providing nutritional advice, often referred to as “Food First” advice. Re-screening is advised monthly in community settings and weekly for hospital patients.
A total score of 2 or more signifies high risk, necessitating a comprehensive nutritional care plan. This frequently includes referral to a dietitian or a specialized nutritional support team. The care plan may involve strategies such as dietary fortification, oral nutritional supplements, or considering artificial nutrition methods if oral intake remains insufficient.
Important Considerations for Accurate Screening
Applying the MUST tool requires careful consideration in specific patient populations for accurate assessments. For individuals with fluid disturbances, such as edema, measured weight may be artificially elevated. Estimating a “dry weight” or adjusting BMI and weight loss measurements is important for a more accurate nutritional assessment.
Patients with amputations challenge standard BMI calculations because the missing limb affects total body weight. Adjustments to body weight or height based on the missing limb are necessary for a more accurate BMI, or alternative anthropometric measurements may be considered.
In cases of critical illness, patients often experience rapid physiological changes and may have difficulty with oral intake. Clinical judgment is particularly important, and the “acute disease effect” score of 2 points is frequently applied, reflecting the severe impact of the illness on nutritional status.