'Malnutrition Universal Screening Tool' MAG

1 must is a fi ve-s tep screeningtool to identifyadults,who are ma ln ou ris hed, at risk of maln utrition(un de rn utri ti on ), or also includesman agement guidelineswhich can be use d to develo pa ca re plan .It is fo r use in hospitals,communityand oth er ca re se ttin gs and ca n be use dby all ca re wor ke decontains:A flow char t sho wing the 5 st eps to use fo r screeningand ma nage men tBM I cha rtWe ight los s tablesAlte rnat ive mea surement s whe n BMI cann ot be ob taine d by measurin g weightand eas e refer toThe must ExplanatoryBookletfor morein formationwh en weightand heightcannotbe measured,andwhe n sc reeningpatientgroupsin whichextra care in interpreta tio n is needed(e .g. thosewith fluid disturbances,pla ste r cas ts, amputations,cr itical illnes s an d pregn ant or lactatingwo men).

2 The bookletcan also be usedfor e must Reportfor su ppo rting evide nce. Pleasenote tha t ' must 'has not bee n designedto detectdef icien cies or excessiveintakesof vit amin s and mineralsand is ' must 'St epsSt ep1 Measure hei ghtandweighttogeta , ep2 Note percentageunplannedweightlossandscoreusi ngtables pro ep4 Addscoresfr omsteps1,2 and3 together toobtainoverall riskof ep5 Usemanagementguidelinesand/orlocalpolicy todevelop Advisory GroupAStandingCommittee ofBAPENMAG'MalnutritionUniversal Screeni ngTool'BAPENA dvancingClinicalNutrition' must 'BAP EN is regi st ered char ity num ber 10 23927 ww BMIscore(&BMI)Height (feet andinches)Weight(stonesandpounds)Weight( kg)Heig ht(m)Note : The blacklinesdenotethe exactcut off points( 30,20and ), figureson the charthave beenroundedto the mRis k2 or moreHighRiskStep5 Management guid elinesObse rveDocum en t dietar y int ak efor 3 days if su bje ct inhosp it al or car e homeIf im pr ove d or ade qua teinta ke littl e cl ini ca lconc ern.

3 If no impr ov em en t cl in ica l con ce rn - fo ll owloca l po licyRepe at sc re eni ngHospi tal weekl yCar e Home at leas t mon th lyCommunity at le ast ev er y2-3 mo nt hsTre at*Refer to di etit ia n, Nutri tio nalSupport Te am or imp leme ntloca l polic yImp ro ve and in cre aseovera ll nu tr iti on al in ta keMo nito r and re vi ew ca re pla nHospi ta l wee klyCare Home mont hl yCommu nit y monthly* Unlessdetr im entalor no benefitis ex pec ted fr om nut ri tionalsupport . im +Step2 Weightlos s sc oreStep3 Acutedis easeef fect sc ore+If unableto ob ta in heightandwe ight,seereverseforal ter nativemea surementsanduseof su bj ec tivecr ite riaStep4 Over al l risk ofmalnutriti onAdd Scor es togethe r to calcu late overall risk of ma lnut rit io nSco re 0 Low Ri sk Sc ore 1 Me dium Risk Score 2 or mor e High RiskRe-a ssesssubjectsidentifiedatriskas th eymovethrough carese ttingsSeeThe must Ex planat or y Bo ok letfor fu rt her deta ils andThe must Rep or tfor supporting evi l riskcategories:Treat un de rl yi ng co nditionand prov ide help andadviceon fo od ch oices,eatingand drinkingwhennec essa ry.

4 Rec ord mal nu tri tion ris k ord ne ed fo r specialdiet s and followloc al ty:Re cord prese nce of obe si ty . Fo r thos e withun derl ying co ndi ti ons , th es e are gene ral lycon tro lled be fo re the tr ea tmen t of ob es >20 (>30 Obes e) = 018. 5-20= 1<18 .5= 2%Score<5= 05-10= 1>10= 2 Unplannedweightlossinpast 3-6monthsIf pa tien t is acu te ly il landther e has bee n or is like lyto be no nut ritio na lintake fo r >5 daysScore2 Routi neclinicalcareRep eat sc re enin gHospi tal weeklyCare Hom es mo nth lyComm uni ty ann ual lyfo rspe ci al group se. g. tho se >75 yr s34kg< > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < > < 5%SCORE1 WtLoss5-10%SCOREWtLoss> 10%Weightbeforeweightloss(kg)

5 St ep2 Weightlossscore5st4lb<4lb4lb 7lb>7lb5st7lb<4lb4lb 8lb>8lb5st11lb<4lb4lb 8lb>8lb6st<4lb4lb 8lb>8lb6st4lb<4lb4lb 9lb>9lb6st7lb<5lb5lb 9lb>9lb6st11lb<5lb5lb 10lb>10lb7st<5lb5lb 10lb>10lb7st4lb<5lb5lb 10lb>10lb7st7lb<5lb5lb 11lb>11lb7st11lb<5lb5lb 11lb>11lb8st<6lb6lb 11lb>11lb8st4lb<6lb6lb 12lb>12lb8st7lb<6lb6lb 12lb>12lb8st11lb<6lb6lb 12lb>12lb9st<6lb6lb 13lb>13lb9st4lb<7lb7lb 13lb>13lb9st7lb<7lb7lb 13lb>13lb9st11lb<7lb7lb 1st 0lb>1st0lb10st<7lb7lb 1st 0lb>1st0lb10st4lb<7lb7lb 1st 0lb>1st0lb10st7lb<7lb7lb 1st 1lb>1st1lb10st11lb<8lb8lb 1st 1lb>1st1lb11st<8lb8lb 1st 1lb>1st1lb11st4lb<8lb8lb 1st 2lb>1st2lb11st7lb<8lb8lb 1st 2lb>1st2lb11st11lb<8lb8lb 1st 3lb>1st3lb12st<8lb8lb 1st 3lb>1st3lb12st4lb<9lb9lb 1st 3lb>1st3lb12st7lb<9lb9lb 1st 4lb>1st4lb12st11lb<9lb9lb 1st 4lb>1st4lb13st<9lb9lb 1st 4lb>1st4lb13st4lb<9lb9lb 1st 5lb>1st5lb13st7lb<9lb9lb 1st 5lb>1st5lb13st11lb<10lb10lb 1st 5lb>1st5lb14st<10lb10lb 1st 6lb>1st6lb14st4lb<10lb10lb 1st 6lb>1st6lb14st7lb<10lb10lb 1st 6lb>1st6lb14st11lb<10lb10lb 1st 7lb>1st7lb15st<11lb11lb 1st 7lb>1st7lb15st4lb<11lb11lb 1st 7lb>1st7lb15st7lb<11lb11lb 1st 8lb>1st8lb15st11lb<11lb11lb 1st 8lb>1st8lb16st<11lb11lb 1st 8lb>1st8lb16st4lb<11lb11lb 1st 9lb>1st9lb16st7lb<12lb12lb 1st9lb>1st9lb0 SCOREWtLoss< 5%SCORE1 WtLoss 5-10%2 SCORE WtLoss > 10%3 Weightbeforeweightloss(stlb)Step1: BMI (bodymassindex)If heightcannotbemeas uredUse re cen tl y doc umented or se lf -re port ed heigh t (if rel iab le an d real isti c).

6 If th e subject doesnot kn ow or is unable to reporttheir hei gh t, use one of the alte rnati vemea sure ments to estimatehe ig ht (ulna,kne e hei ght or de mispa n) .If height&weightcannotbe obta inedUse mi d upperarm circumferen ce (MUAC)mea surement to estimate BMI : Recentunplannedweight lossIf rec en t wei ght loss cann ot be ca lculated,use se lf-rep ortedwe igh t loss (if reliablean d real istic).Subjectivecr it eriaIf hei gh t, weigh t or BMI ca nn ot be obtai ned, th e fol lowin g cri te ri a wh ich relateto themcan assistyourprofe ssio nal judge me nt of th e su bje ct s nut ri tio na l risk cate ase note , use of thesecriteriaisnot de si gnedto assigna BMICl ini cal imp res sion thin , acce ptabl e weig ht, overweight. Obvious wa sti ng (ver y th in) and obesi ty(veryoverweight ) can also be note Unpl annedweight lossCl ot he s and/ or jewe llery have be co me loosefitti ng (weight lo ss).

7 Hist ory of dec rea se d foo d in tak e, re ducedapp etite or swa llowi ng prob lems over 3-6 monthsandund erl yin g dis eas e or psycho-so ci al /physical disa bil iti es likel y to ca use Acutediseaseeff ectNo nu tr it io nal int ak e or lik el ih oo d of no intakefor moretha n 5 da rth er deta il s on tak in g alte rn at ive measurements, special circumstances and subjective cri teria canbe fo und inThe must ExplanatoryBooklet. A cop y ca n be downl oad ed at www . d from the BAPEN offi ce . The full evid en ce -b ase fo r MU ST is containedinThe must Reportand is al so avai la ble for pu rcha se fr om the , Se cure Hol d Busi ness Cen tre, Stud ley Roa d, Re ddi tc h, Worcs,B98 7LG. Te l: 01527457 : 01527458 pe n@ so ve re ig nconferenc BAPENis re gi ste re d ch arity nu mbe r 1023927.

8 Uk BAPEN2003IS BN 1 89946790 4 Price ri ghts re serve d. This doc ume nt may be ph otocopi ed for di ss emi na ti on and tra ining purposes as long as the so urceis cr ed ited and y ma y be rep roducedfor the pu rp osesof pu bli city and pro moti on . Writtenpe rmis sion mustbe soughtfrom BAPENif rep roductionorad ap tatio n is re quired. If use d for co mme rc ial gai n a li cen ce fee may be req BAPEN. Fir st pub lish ed May 20 04 by MAG the MalnutritionAdv isor y Group,a Standing Committeeof wit h min or ch an gesMarch2008 MU ST is su pp ort ed by th e Br it ish DieteticAssociation, the RoyalCollegeof Nursi ng and the RegisteredNursingHo me Ass oc ia ti on .Al ternativemeasurements:instructionsandtab lesIf he ight can no t be obtained, us e le ngth of fo rea rm (uln a) to calcu la te heightus ing tablesbelow.

9 (S ee The M US T ExplanatoryBooklet fordetailsof other alte rnativemeas urements(knee height an dde mis pan) th at ca n alsobeus edto estimate height).Estimatingheightfromuln a lengthMeasure bet wee n the point of th e elb ow(o lecr anonpro ces s) and th e midp oint of th e promin entbone of the wr ist (s ty loid pr oce ss ) (le ft side if possib le) .EstimatingBMIcategoryfrommid upperarmcir cumference(MUAC)Th e subje ct s lef t ar m sho uld be be nt at the elb ow at a 90 de gre e an gle ,wi th the upper arm hel d par alle l to the sid e of th e bo dy. Me as ure thedis tan ce bet weenthe bo ny prot rusio n on th e sh ould er (ac ro mio n) andthe poi nt of the elbow (ole cr an on pr ocess). Ma rk th e mid -p oint .Ask the subj ect to let arm hang loos e and mea sure arou ndthe up per ar m at the mid- po int , ma king sure tha t the tap emeas ure is snu g but no t tigh MUA C is < cm, BMI is likely to be <20 kg/ MUA C is > cm, BMI is likely to be >30 kg/ use of MUACpr ovid es a ge ne ra l indicationof BMI and is not des ign ed to gen eratean actua l scor e foruse wit h MU ST.

10 For fur th er inf orma tion on use of MUAC pleaserefer toThe must Ex planatory Bo (<65years) (>65years) (cm) (<65 years) (>65 years) (<65years) (>65years) (cm) (<65 years) (>65 years) (m)HEIGHT(m)HEIGHT(m)HEIGHT(m)