'Malnutrition Universal Screening Tool' MAG

1 MUST is a five-step Screening tool to identifyadults,who are malnourished, at risk of malnutrition(undernutrition), or obese. It also includes management guidelines which can be used to developa care is for use in hospitals, community and other care settings and can be usedby all care guide contains:A flow chart showing the 5 steps to use for Screening and managementBMI chartWeight loss tablesAlternative measurements when BMI cannot be obtained by measuring weight and refer toThe MUST Explanatory Bookletfor more information when weight and height cannot be measured, andwhen Screening patient groups in which extra care in interpretation is needed ( those with fluid disturbances,plaster casts, amputations, critical illness and pregnant or lactating women). The booklet can also be used for MUST Reportfor supporting evidence. Please note that 'MUST' has not been designed to detectdeficiencies or excessive intakes of vitamins and minerals and is ofuse only in 5 'MUST' StepsStep 1 Measure height and weight to get a BMI score using chart , 2 Note percentage unplanned weight loss and score using tables 3 Establish acute disease effect and 4 Add scores from steps 1, 2 and 3 together to obtain overall risk of 5 Use management guidelines and/or local policy to develop care Advisory GroupAStandingCommittee ofBAPENMAG 'Malnutrition Universal Screening Tool' BAPENA dvancingClinicalNutrition'MUST'BAPEN is registered charity number 1023927 1 BMI score (& BMI)Height (feet and inches)Weight (stones and pounds)Weight (kg)Height (m)Note.

2 The black lines denote the exact cut off points ( 30,20 and kg/m2), figures on the chart have been rounded to the nearest whole Risk1 Medium Risk2 or moreHigh RiskStep5 Management guidelinesObserveDocument dietary intakefor 3 days if subject inhospital or care homeIf improved or adequateintake little clinicalconcern; if no improvement clinical concern - followlocal policyRepeat screeningHospital weeklyCare Home at least monthlyCommunity at least every2-3 monthsTreat*Refer to dietitian, NutritionalSupport Team or implementlocal policyImprove and increaseoverall nutritional intakeMonitor and review care planHospital weeklyCare Home monthlyCommunity monthly* Unless detrimental or no benefitis expected from nutritionalsupport imminent score+Step2 Weight loss scoreStep3 Acute disease effect score+If unable to obtain height and weight,see reverse for alternativemeasurements and use of subjectivecriteriaStep4 Overall risk of malnutritionAdd Scores together to calculate overall risk of malnutritionScore 0 Low Risk Score 1 Medium Risk Score 2 or more High RiskRe-assess subjects identified at risk as they move through care settingsSeeThe MUST Explanatory Bookletfor further details andThe MUST Reportfor supporting risk categories.

3 Treat underlying condition and provide help andadvice on food choices, eating and drinking malnutrition risk need for special diets and follow local :Record presence of obesity. For those withunderlying conditions, these are generallycontrolled before the treatment of kg/m2 Score>20(>30 Obese) = 1< 2%Score<5= 05-10= 1>10= 2 Unplannedweight loss inpast 3-6 monthsIf patient is acutely illandthere has been or is likelyto be no nutritionalintake for >5 daysScore 2 Routine clinical careRepeat screeningHospital weeklyCare Homes monthlyCommunity annuallyforspecial those >75 yrs34kg< > kg< > kg< > kg< > kg< > kg< > kg< > kg< > < > kg< > kg< > kg< > kg< > < > kg< > kg< > < > kg< > kg< > kg< > kg< > < > kg< > kg< > kg< > kg< > kg< > kg< > kg< > kg< > kg< > kg< > kg< > < > kg< > kg< > kg< > kg< > kg< > kg< > kg< > kg< > kg< > kg< > kg< > kg< > kg< > 0Wt Loss < 5%SCORE 1Wt Loss 5-10%SCOREWt Loss > 10%Weight before weight loss (kg)

4 Step 2 Weight loss score5st4lb<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>1st 0lb10st<7lb7lb 1st 0lb>1st 0lb10st 4lb<7lb7lb 1st 0lb>1st 0lb10st 7lb<7lb7lb 1st 1lb>1st 1lb10st 11lb<8lb8lb 1st 1lb>1st 1lb11st<8lb8lb 1st 1lb>1st 1lb11st 4lb<8lb8lb 1st 2lb>1st 2lb11st 7lb<8lb8lb 1st 2lb>1st 2lb11st 11lb<8lb8lb 1st 3lb>1st 3lb12st<8lb8lb 1st 3lb>1st 3lb12st 4lb<9lb9lb 1st 3lb>1st 3lb12st 7lb<9lb9lb 1st 4lb>1st 4lb12st 11lb<9lb9lb 1st 4lb>1st 4lb13st<9lb9lb 1st 4lb>1st 4lb13st 4lb<9lb9lb 1st 5lb>1st 5lb13st 7lb<9lb9lb 1st 5lb>1st 5lb13st 11lb<10lb10lb 1st 5lb>1st 5lb14st<10lb10lb 1st 6lb>1st 6lb14st4lb<10lb10lb 1st 6lb>1st 6lb14st 7lb<10lb10lb 1st 6lb>1st 6lb14st 11lb<10lb10lb 1st 7lb>1st 7lb15st<11lb11lb 1st 7lb>1st 7lb15st4lb<11lb11lb 1st 7lb>1st 7lb15st 7lb<11lb11lb 1st 8lb>1st 8lb15st 11lb<11lb11lb 1st 8lb>1st 8lb16st<11lb11lb 1st 8lb>1st 8lb16st4lb<11lb11lb 1st 9lb>1st 9lb16st 7lb<12lb12lb 1st 9lb>1st 9lb0 SCOREWt Loss < 5%SCORE 1 WtLoss 5-10%2 SCORE WtLoss > 10%3 Weight before weight loss (st lb)Step 1: BMI (body mass index)If height cannot be measuredUse recently documented or self-reported height (if reliable and realistic).

5 If the subject does not know or is unable to report their height, use one of the alternativemeasurements to estimate height (ulna, knee height or demispan).If height & weight cannot be obtainedUse mid upper arm circumference (MUAC) measurement to estimate BMI 2: Recent unplanned weight lossIf recent weight loss cannot be calculated, use self-reported weight loss (if reliable and realistic).Subjective criteriaIf height, weight or BMI cannot be obtained, the following criteria which relate to them can assist yourprofessional judgement of the subject s nutritional risk category. Please note, use of these criteria isnot designed to assign a BMIC linical impression thin, acceptable weight, overweight. Obvious wasting (very thin) and obesity(very overweight) can also be Unplanned weight lossClothes and/or jewellery have become loose fitting (weight loss).History of decreased food intake, reduced appetite or swallowing problems over 3-6 months andunderlying disease or psycho-social/physical disabilities likely to cause weight Acute disease effectNo nutritional intake or likelihood of no intake for more than 5 details on taking alternative measurements, special circumstances and subjective criteria canbe found inThe MUST Explanatory Booklet.

6 A copy can be downloaded at orpurchased from the BAPEN office. The full evidence-base for MUST is contained inThe MUST Reportand is also available for purchase from the BAPEN Office, Secure Hold Business Centre, Studley Road, Redditch, Worcs, B98 7LG. Tel: 01527 457 850. Fax: 01527 458 BAPEN is registered charity number 1023927. BAPEN 2003 ISBN 1 899467 90 4 Price rights reserved. This document may be photocopied for dissemination and training purposes as long as the sourceis credited and may be reproduced for the purposes of publicity and promotion. Written permission must be sought from BAPEN if reproduction oradaptation is required. If used for commercial gain a licence fee may be measurements and considerations BAPEN. First published May 2004 by MAG the Malnutrition Advisory Group, a Standing Committee of and reprinted with minor changes March 2008 MUST is supported by the British Dietetic Association, the Royal College of Nursing and the Registered Nursing Home measurements: instructions and tablesIf height cannot be obtained, use length of forearm (ulna) to calculate height using tables below.

7 (See The MUST Explanatory Booklet for details of other alternative measurements (knee height anddemispan) that can also be used to estimate height).Estimating height from ulna lengthMeasure between the point of the elbow(olecranon process) and the midpoint of the prominentbone of the wrist (styloid process) (left side if possible).Estimating BMI category from mid upper arm circumference (MUAC)The subject s left arm should be bent at the elbow at a 90 degree angle,with the upper arm held parallel to the side of the body. Measure thedistance between the bony protrusion on the shoulder (acromion) andthe point of the elbow (olecranon process). Mark the the subject to let arm hang loose and measure aroundthe upper arm at the mid-point, making sure that the tapemeasure is snug but not MUAC is < cm, BMI is likely to be <20 MUAC is > cm, BMI is likely to be >30 use of MUAC provides a general indication of BMI and is not designed to generate an actual score foruse with MUST.

8 For further information on use of MUAC please refer toThe MUST Explanatory (<65 years) (>65 years) length (cm) (<65 years) (>65 years) (<65years) (>65 years) length (cm) (<65 years) (>65 years) (m)HEIGHT(m)HEIGHT(m)HEIGHT(m)