🍽️nutrition assessment review
8.3 Malnutrition Universal Screening Tool (MUST)
6 min read•Last Updated on July 30, 2024
The Malnutrition Universal Screening Tool (MUST) 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 BMI, 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 patient outcomes
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 unintentional weight loss 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 acute disease effect 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 dietitian or nutrition support team for further assessment and intervention
- Initiation of oral nutritional supplements 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