Makindo Medical Notes

Related Subjects: |Malnutrition universal screening tool (MUST) |Body Mass Index |Peripherally inserted central catheters (PICC) |Refeeding syndrome

Introduction

• The Malnutrition Universal Screening Tool (MUST) is a validated, evidence‐based tool developed to identify adults at risk of malnutrition in a variety of healthcare settings.
• Adapted from the MUST Report (Elia M, ed., Report No. 152, 2003) by the Malnutrition Advisory Group of the British Association for Parenteral and Enteral Nutrition (BAPEN), MUST offers a standardized method to screen, assess, and monitor nutritional status.

Diagram

Background and Rationale

Malnutrition is a prevalent issue among hospitalized patients and in community settings, often leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. Recognizing the need for a simple yet robust screening method, MUST was developed to provide clinicians with a tool that could be universally applied to adults regardless of the care environment. Its design reflects both research evidence and expert consensus on the risk factors and clinical outcomes associated with malnutrition.

Purpose of MUST

The primary objective of MUST is to facilitate the early detection of nutritional risk so that appropriate interventions can be initiated. By identifying patients at low, medium, or high risk of malnutrition, healthcare providers can tailor nutritional support and treatment plans, thereby improving patient outcomes and reducing complications associated with malnutrition.

Components and Scoring

MUST incorporates three key parameters, each contributing to an overall risk score:

• Body Mass Index (BMI): Patients are assigned a score based on their BMI, reflecting their current nutritional status.
• Unplanned Weight Loss: This parameter evaluates recent unintentional weight loss over a defined period (typically 3-6 months). Greater weight loss yields a higher risk score.
• Acute Disease Effect: For patients who are acutely ill and have had, or are likely to have, no nutritional intake for more than 5 days, an additional score is assigned.

The scores from these three parameters are summed to give an overall risk rating:

• 0 points: Low risk
• 1 point: Medium risk
• 2 or more points: High risk

Clinical Applications

MUST is used across multiple care settings, including hospitals, primary care clinics, and community health centers. Its applications include:

• Early Identification: Promptly identifying patients at risk of malnutrition enables timely nutritional interventions.
• Monitoring and Follow-Up: MUST facilitates ongoing monitoring of nutritional status, ensuring that changes in risk are identified and addressed.
• Treatment Planning: The risk stratification provided by MUST helps guide the level of nutritional support required, from dietary advice to specialist referral.
• Resource Allocation: By standardizing screening, MUST assists healthcare institutions in optimizing resource allocation for nutritional support services.

Conclusion

The Malnutrition Universal Screening Tool (MUST) is a cornerstone in the assessment of nutritional status in adults. Its simple, yet comprehensive approach—integrating BMI, unplanned weight loss, and the acute disease effect—allows healthcare providers to identify and address malnutrition early. By facilitating prompt intervention and continuous monitoring, MUST plays a critical role in improving patient outcomes and reducing the burden of malnutrition in diverse clinical settings.