8.3 Malnutrition Universal Screening Tool (MUST)
6 min read•july 30, 2024
The is a quick, easy-to-use method for identifying adults at risk of malnutrition. It's widely used in hospitals and community settings, requiring minimal training and equipment. MUST helps healthcare pros spot malnutrition early, enabling timely intervention.
MUST involves measuring , assessing weight loss, and considering acute disease effects. Scores determine risk levels, guiding care plans from simple monitoring to comprehensive nutritional support. MUST's effectiveness is backed by research, showing it can predict hospital stays and mortality rates.
Malnutrition Universal Screening Tool (MUST)
Purpose and Target Population
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- 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
- MUST is intended for use in hospitals, community settings, and other healthcare facilities to identify individuals who may benefit from nutritional intervention or further assessment
- The tool is designed to be quick and easy to use, requiring minimal training and equipment, making it suitable for use by a wide range of healthcare professionals
- MUST is validated for use in adult populations, including the elderly, but is not intended for use in pediatric or pregnant populations
- The purpose of MUST is to provide a standardized approach to identifying malnutrition risk, facilitating early intervention and improved
Benefits and Advantages
- MUST is a simple and practical tool that can be administered by various healthcare professionals (nurses, doctors, dietitians) with minimal training
- The tool requires only basic equipment (height measure, weighing scale) and can be completed in a short amount of time (less than 5 minutes)
- MUST has been extensively validated in different healthcare settings (hospitals, community care, long-term care facilities) and has shown good reliability and predictive validity
- The use of MUST can help identify patients at risk of malnutrition early, enabling timely intervention and prevention of adverse outcomes (prolonged hospital stay, complications, mortality)
- MUST scores provide a standardized way of communicating malnutrition risk among healthcare professionals, facilitating continuity of care and appropriate referrals
MUST Assessment Process
Anthropometric Measurements
- Step 1: Measure height and weight to calculate body mass index (BMI)
- If unable to obtain height and weight, use alternative measurements such as mid-upper arm circumference or ulna length to estimate BMI
- BMI is calculated using the formula: weight (kg) / height (m)^2
- BMI categories:
-
20 = 0 points
- 18.5-20 = 1 point
- <18.5 = 2 points
-
Weight Loss and Acute Disease Effect
- Step 2: Document in the past 3-6 months, expressed as a percentage of body weight
- Use patient records, patient self-reporting, or other reliable sources to determine weight loss
- Weight loss categories:
- <5% = 0 points
- 5-10% = 1 point
-
10% = 2 points
- Step 3: Assess and determine if there has been or is likely to be no nutritional intake for more than 5 days
- Acute disease effect (no nutritional intake >5 days) = 2 points
- No acute disease effect = 0 points
Scoring and Care Planning
- Step 4: Add scores from steps 1, 2, and 3 to obtain the overall risk of malnutrition score
- Step 5: Use the overall score to determine the risk category and develop a care plan based on local policy
- The care plan may include:
- Referral to a or nutrition support team for further assessment and intervention
- Initiation of oral or dietary modifications
- Monitoring of food intake and weight changes
- Patient education and counseling on nutrition and lifestyle changes
MUST Scores and Risk Categories
Low Risk (Score 0)
- A MUST score of 0 indicates a low risk of malnutrition
- Patients should be rescreened at regular intervals, with the frequency determined by local policy (e.g., every 6 months in community settings, weekly in acute care)
- No specific nutritional intervention is required, but general healthy eating advice may be provided
Medium Risk (Score 1)
- A MUST score of 1 indicates a medium risk of malnutrition
- These patients should have a documented nutrition care plan, be monitored regularly, and consider referral to a dietitian if no improvement occurs
- The nutrition care plan may include:
- Encouraging high-energy, high-protein foods and fluids
- Providing oral nutritional supplements (e.g., fortified drinks, puddings)
- Monitoring food intake and weight changes
- Reviewing and adjusting the care plan as needed
High Risk (Score 2 or more)
- A MUST score of 2 or more indicates a high risk of malnutrition
- These patients should be referred to a dietitian or nutrition support team for a comprehensive assessment and individualized nutrition care plan
- The nutrition care plan may include:
- Initiating or adjusting oral, enteral, or parenteral nutrition support
- Addressing any underlying medical conditions or social factors contributing to malnutrition
- Close monitoring of nutritional status and response to intervention
- Involving multidisciplinary team members (e.g., speech therapist for swallowing assessment, social worker for meal assistance)
- In obese patients, a high MUST score may indicate the presence of sarcopenic obesity, characterized by reduced muscle mass and increased fat mass, which is associated with increased morbidity and mortality
Interpreting Scores in Context
- MUST scores should be interpreted in the context of the patient's overall clinical condition, considering factors such as age, comorbidities, and treatment goals
- The score should be used as a trigger for further assessment and intervention, rather than a definitive diagnosis of malnutrition
- The frequency of rescreening and the specific interventions recommended may vary depending on the healthcare setting and local policies
Effectiveness of MUST in Healthcare Settings
Validation Studies
- MUST has been extensively validated in various healthcare settings, including hospitals, community care, and long-term care facilities, demonstrating good reliability and predictive validity
- Studies have shown that MUST has good agreement with other validated nutrition screening tools, such as the Mini Nutritional Assessment (MNA) and the Subjective Global Assessment (SGA)
- MUST has been found to have high sensitivity (ability to correctly identify those at risk of malnutrition) and specificity (ability to correctly identify those not at risk) when compared to a full nutritional assessment by a dietitian
Predictive Value
- In acute care settings, MUST has been shown to predict length of hospital stay, mortality, and readmission rates, highlighting its utility in identifying patients who may benefit from nutritional intervention
- For example, a study in an acute hospital setting found that patients with a high MUST score (≥2) had a significantly longer length of stay (median 14 days) compared to those with a low score (median 5 days)
- In community settings, MUST has been effective in identifying older adults at risk of malnutrition, enabling early intervention and prevention of adverse outcomes such as hospitalization and functional decline
- A study in community-dwelling older adults found that those with a high MUST score (≥2) had a significantly higher risk of hospital admission (odds ratio 2.17) and mortality (odds ratio 2.56) over a 1-year follow-up period
Factors Influencing Effectiveness
- The effectiveness of MUST may be influenced by factors such as the training and expertise of the healthcare professionals using the tool, the availability of resources for nutritional intervention, and the adherence to local policies and protocols for managing malnutrition risk
- Regular audits and quality improvement initiatives can help ensure the consistent and effective use of MUST in different healthcare settings, optimizing patient outcomes and resource utilization
- For example, implementing a training program for nurses on using MUST and providing regular feedback on screening rates and accuracy can improve the reliability and validity of the tool in clinical practice
- The integration of MUST into electronic health records and clinical decision support systems can also enhance its effectiveness by prompting timely screening, generating automated referrals, and facilitating data collection and analysis for quality improvement purposes
Key Terms to Review (18)
Acute disease effect: Acute disease effect refers to the immediate physiological changes and nutritional impacts that occur in an individual during or following the onset of a sudden illness. This condition can significantly alter metabolic processes, nutrient requirements, and overall health status, often leading to malnutrition if not properly managed. Understanding this effect is crucial for assessing nutritional needs, particularly when utilizing screening tools to evaluate malnutrition risk in patients experiencing acute health issues.
Aspen Recommendations: The Aspen Recommendations are guidelines developed by the American Society for Parenteral and Enteral Nutrition (ASPEN) aimed at improving the identification and management of malnutrition in patients. These recommendations emphasize the importance of using standardized screening tools, such as the Malnutrition Universal Screening Tool (MUST), to assess nutritional risk and provide effective interventions to address malnutrition in various healthcare settings.
BMI: Body Mass Index (BMI) is a simple calculation used to assess body weight relative to height, providing an estimate of body fatness and categorizing individuals into different weight status categories. This measurement is crucial for evaluating health risks associated with obesity, underweight, and other weight-related conditions, linking directly to various assessments of health and nutrition.
Dietary intervention: Dietary intervention refers to a structured approach aimed at modifying an individual's dietary habits to improve health outcomes or manage specific health conditions. This process often includes personalized dietary recommendations, education on nutrition, and the implementation of changes in food choices to achieve specific health goals, such as weight management, nutrient deficiencies, or chronic disease management.
Dietitian: A dietitian is a trained professional who specializes in the study of nutrition and its impact on health, providing evidence-based guidance on dietary practices. They work with individuals and groups to create personalized nutrition plans that promote health, manage diseases, and improve overall well-being. Dietitians are key players in using tools like the Malnutrition Universal Screening Tool (MUST) to assess nutritional status and identify those at risk of malnutrition.
Early identification: Early identification refers to the prompt recognition of individuals at risk of malnutrition or experiencing its effects, allowing for timely interventions. This concept is crucial in nutrition assessment, especially in settings where malnutrition can lead to severe health consequences. By identifying individuals early, healthcare providers can implement strategies to prevent further decline in nutritional status and improve overall health outcomes.
Hospitalization risk: Hospitalization risk refers to the likelihood that an individual will require admission to a hospital due to health complications, often linked to underlying conditions such as malnutrition or chronic illness. This risk is assessed to determine the need for preventive measures and targeted interventions, especially in vulnerable populations who may face adverse health outcomes.
Intervention strategies: Intervention strategies refer to planned actions or approaches designed to improve health outcomes or address specific nutritional needs. These strategies often involve tailored programs that are based on assessments of individual or group nutritional status and aim to enhance dietary intake, promote healthy behaviors, or manage health conditions related to nutrition. They play a crucial role in addressing malnutrition and can include education, dietary modifications, supplementation, or community-based programs.
Malnutrition Universal Screening Tool (MUST): The Malnutrition Universal Screening Tool (MUST) is a validated screening tool designed to identify adults who are malnourished or at risk of malnutrition. MUST assesses body mass index (BMI), recent weight loss, and acute illness effects, providing a quick and effective way to determine the nutritional status of individuals, especially in healthcare settings, where early intervention can significantly improve health outcomes.
NICE Guidelines: NICE guidelines are evidence-based recommendations created by the National Institute for Health and Care Excellence in the UK, designed to improve health outcomes and provide clear guidance on health and social care practices. These guidelines cover various aspects of healthcare, including diagnosis, treatment, and prevention strategies, ensuring that individuals receive consistent and high-quality care across different settings.
Nurse: A nurse is a licensed healthcare professional who provides care, support, and education to patients in various settings. Nurses play a vital role in assessing patient needs, implementing care plans, and monitoring health outcomes, particularly in relation to nutrition and malnutrition assessments, such as the Malnutrition Universal Screening Tool (MUST). Their expertise helps in identifying patients at risk of malnutrition and coordinating with other healthcare providers to deliver comprehensive care.
Nutritional supplements: Nutritional supplements are products designed to enhance or complement the diet, providing essential nutrients such as vitamins, minerals, amino acids, and fatty acids. These supplements can play a crucial role in addressing deficiencies, especially in populations that may be at risk, such as the elderly or those with specific health conditions. They can be used to support nutritional needs, improve overall health, and help manage chronic diseases.
Over-nutrition: Over-nutrition refers to the excessive intake of nutrients, particularly calories, leading to overweight and obesity. This condition is often characterized by an imbalance in energy intake and expenditure, resulting in an accumulation of body fat that can negatively impact health. Over-nutrition can contribute to various health issues, including metabolic disorders, cardiovascular diseases, and reduced quality of life.
Patient outcomes: Patient outcomes refer to the results of healthcare interventions and the overall impact on a patient's health status after receiving care. These outcomes can include changes in health conditions, quality of life, and patient satisfaction. Understanding patient outcomes is crucial for evaluating the effectiveness of treatments and interventions, as well as guiding future healthcare decisions.
Risk Categories: Risk categories refer to classifications used to determine the likelihood of an individual experiencing malnutrition based on specific criteria. These categories help identify individuals at varying levels of risk, guiding healthcare providers in implementing appropriate nutritional interventions and monitoring strategies.
Scoring criteria: Scoring criteria refer to the standardized benchmarks used to evaluate and assess nutritional risk based on specific indicators. These criteria play a crucial role in the Malnutrition Universal Screening Tool (MUST) by providing a systematic way to identify individuals at risk of malnutrition, ensuring that the assessment is both objective and reliable. By using scoring criteria, healthcare providers can make informed decisions regarding the necessary interventions and support needed for those identified as at risk.
Under-nutrition: Under-nutrition refers to a state of insufficient nutrient intake that leads to measurable adverse effects on health and development. This condition can stem from inadequate dietary intake, poor absorption of nutrients, or increased nutrient needs due to illness or physical activity. Understanding under-nutrition is crucial as it often leads to a range of health issues, including impaired growth in children, weakened immunity, and increased vulnerability to disease.
Unintentional weight loss: Unintentional weight loss refers to a decrease in body weight that occurs without the individual actively trying to lose weight, often indicating an underlying health issue. This can be a sign of malnutrition, chronic illness, or psychological factors and is crucial for assessing nutritional status. Identifying unintentional weight loss is vital for determining the need for further evaluation and intervention in various health settings.