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    Chief Complaint


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    Patent Pending

    Malnutrition Universal Screening Tool (MUST)

    Identifies patients who are malnourished or at risk of malnutrition.


    Use in patients ≥18 years old. May be applied in either a hospital or community setting.

    When to Use
    Why Use

    • Patients at risk for malnutrition.

    • Per BAPEN guidelines, patients should be screened at the following intervals:

      • Hospital inpatients: weekly.

      • Patients in community care homes: monthly.

      • Outpatients: annually if low risk, monthly to every 3 months depending on clinical status if not low risk.

    • If height cannot be measured, recently documented or self-reported height may be used, if reliable and realistic.

    • If the patient does not know or cannot report their height, height may be estimated by one of the following: ulna length, knee height, demispan.

    • If height and weight cannot be obtained, use mid-upper arm circumference (MUAC) in place of BMI.

    • Training staff to correctly score MUST and to take appropriate next steps in management is an important barrier to universal and routine implementation of this scoring system.

    • High nursing staff turnover can be an important confounding factor in MUST use.

    • Simple behavioral methods of support can be used to encourage oral intake, such as encouraging patients to eat and/or eat in small portions, providing patients with favorite meals, and assisting patients with feeding.

    • MUST is primarily used in the UK. 

    • If untreated, malnutrition can lead to poorer health outcomes with increased morbidity and significantly reduced quality of life.

    • Studies have shown that patients who are malnourished access health services more often in both acute hospital and primary care settings (Murphy 2018).

    • When admitted, patients who are malnourished have more complications, longer inpatient stays, and higher mortality rates (NICE 2006).

    • Routine use of this screening tool can objectively identify patients who are at risk of malnutrition or suffering from malnourishment. Subsequent intervention can mitigate poorer health outcomes.



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    Creator Insights
    Dr. Marinos Elia

    About the Creator

    Marinos Elia, MD, BSc (Hons), FRCP, is a professor of clinical nutrition and metabolism at the University of Southampton in the UK. He was previously the editor-in-chief of Clinical Nutrition and chair of the British Association for Parenteral and Enteral Nutrition (BAPEN). Dr. Elia’s primary research is focused on nutritional screening and health economics of malnutrition.

    To view Dr. Marinos Elia's publications, visit PubMed

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    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Lorcan Martyn, MB BCh BAO
    About the Creator
    Dr. Marinos Elia
    Are you Dr. Marinos Elia?
    Content Contributors
    • Lorcan Martyn, MB BCh BAO