Malnutrition screening

Discuss the MUST tool for malnutrition screening?

Malnutrition Universal Screening Tool (‘MUST’) is an evidence based tool designed to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese. NICE 2006 recommends the use of MUST

MUST has been developed for use in

  • All adults (sick and healthy)
  • Hospital inpatients
  • Outpatients
  • In the community

MUST is a five step screening tool;

Step 1

Measure height and weight to get a BMI score. If unable to measure height and/or weight, use alternative procedures;

If height cannot be measured
Use recently documented or self-reported height (if reliable and realistic).
If the subject does not know or is unable to report their height, use one of the alternative measurements to estimate height (ulna, knee height or demispan).
If height & weight cannot be obtained
Use mid upper arm circumference (MUAC) measurement to estimate BMI category.

Step 2
Note percentage unplanned weight loss and score using tables provided.
If recent weight loss cannot be calculated, use self-reported weight loss (if reliable and realistic).

Step 3
Establish acute disease effect and score.

Step 4
Add scores from steps 1, 2 and 3 together to obtain overall risk of malnutrition.

Step 5
Use management guidelines and/or local policy to develop care plan.

Step 1
BMI score
Step 2
Weight loss score
Step 3
Acute disease effect score
BMI (kg/m2)   Score
>20                  0
18.5-20            1
<18.5               2
Unplanned Wt loss in past 3-6 m
%                                   Score
<5                                    0
5-10                                 1
>10                                  2
If pt is acutely ill and there has been  or is likely to be no nutritional intake for > 5 days

Score 2

Step 4
Overall risk of malnutrition
Add scores together to calculate overall risk of malnutrition
Score 0 Low risk           Score 1  Medium risk                 Score 2 or more High risk
Low Risk
Routine clinical care
Repeat screening at weekly intervals in hospital
Medium risk

  • Document dietary intake for 3 days
  • If improved or adequate intake- little clinical concern. If not- follow local policy
  • Repeat screening weekly
2 or more
High risk
Refer to dietician or NST



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