‘Malnutrition Universal Screening Tool’ (‘MUST’)
Name:
Step 1:
Step 2:
Step 3:
Step 4:
Step 5:
Date of Birth:
Measure height and weight to get a BMI score using the ‘body mass index category’ table overleaf. If unable to obtain height refer to the
‘subjective factors’ section overleaf.
Note percentage unplanned weight loss and score using the ‘unintentional weight loss category’ table overleaf.
Establish acute disease effect and score.
Add scores from steps 1, 2 and 3 together to obtain overall risk of malnutrition.
For residents identified as moderate or high risk of undernutrition, complete a care plan based on the recommendations in undernutrition
risk category table and implement the dietary interventions.
Pre-assessment
details:
Date
NHS number:
Height:
Present
weight
(kg)
Step 1:
BMI category
score
Weight 3-6 months ago
or usual weight:
Step 2:
Weight loss
category score
Step 3 (if appropriate)
Acute disease
effect
Total risk
undernutrition
score
Signed
Undernutrition risk category
Risk category
Criteria
High
2 or more
ACTION POINTS to include in a nutrition care plan
Moderate
1
1.
2.
3.
4.
5.
6.
Provide a fortified diet2
Provide 2 nourishing snacks a day in-between meals1
Provide nourishing drinks during the day, such as milky drinks, fruit juice, alcohol
Provide a multivitamin and mineral tablet daily
Complete food record charts for 4 days, then review
Weigh weekly. Re-screen monthly
Low
0
•
No action necessary. Re-screen monthly
1. Provide 2 homemade fortified drinks a day3
2. Provide a fortified diet
3. Provide 2 nourishing snacks a day in-between meals1
4. Provide a multivitamin and mineral tablet daily
5. Complete food record charts for 4 days, then review
6. Weigh weekly. Re-screen monthly
If high risk for 2 consecutive months and weight has declined refer resident to GP for an assessment for Complan Shake
Nourishing snacks: a slice malt loaf, piece of cake, 1⁄2 scone, 1⁄2 teacake, small sandwich, flapjack, chocolate
Fortified diet: add 1 heaped tablespoon milk powder & 2 tablespoons of double cream to 1 portion of food, such as custard, porridge, soup,
milk pudding
3
Home made fortified drinks: 200mls full cream milk, 1 heaped tablespoon milk powder mixed with either milkshake syrup, hot chocolate,
malted drink, coffee to taste (provides average 300 calories, 10g protein)
1
2
Copyright © 2011 Darlington Primary Care Trust.
Developed by Rachael Masters of Darlington Primary Care Trust
www.focusonundernutrition.co.uk
1
Undernutrition screening criteria
Based on the ‘Malnutrition Universal Screeing Tool’ © BAPEN
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023927
Step 2: Unintentional weight loss category
Step 1: Body mass index category
* Exceptions to category 1 are healthy subjects with no
weight loss (<5%/score 0), or with weight gain, should be
given a score of “0”. (Refer to the www.bapen.org.uk for
alternative methods to determine a resident’s height.).
Height
(ft)
(m)
6’3
6’2½
6’2
6’1½
6’1
6’0½
6.0
5’11½
5’11
5’10½
5’10
5’9½
5’9
5’8½
5’8
5’7½
5.7
5’6½
5’6
5’5½
5’5
5’4½
5’4
5’3½
5’.3
5’2½
5’2
5’1½
5’1
5’0½
5’0
4’11½
4’11
4’10
4’9½
1.90
1.89
1.88
1.86
1.85
1.84
1.82
1.81
1.80
1.79
1.77
1.76
1.75
1.74
1.72
1.71
1.70
1.68
1.67
1.66
1.65
1.63
1.62
1.61
1.60
1.58
1.57
1.56
1.54
1.53
1.52
1.51
1.49
1.47
1.46
Unintentional weight loss in the previous 3–6 months.
If weight loss is intentional or planned for obesity,
score “0”
Weight (kg)
(before
weight loss)
Weight range (kg) for BMI
2
(<18.5)
< = less than
1*
(18.5 – 20)
0
(>20)
> more than
<66.8
<66.1
<65.4
<64.0
<63.3
<62.6
<61.3
<60.6
<59.9
<59.3
<58.0
<57.3
<56.7
<56.0
<54.7
<54.1
<53.5
<52.2
<51.6
<51.0
<50.4
<49.2
<48.6
<48.0
<47.4
<46.8
<46.2
<45.0
<43.2
<43.3
<42.7
<42.2
<41.1
<40.0
<39.4
66.8 – 72.2kg
66.1 – 71.4kg
65.4 – 70.7kg
64.0 – 69.2kg
63.3 – 68.5kg
62.6 – 67.7kg
61.3 – 66.2kg
60.6 – 65.5kg
59.9 – 64.8kg
59.3 – 64.1kg
58.0 – 63.4kg
57.3 – 62.0kg
56.7 – 61.3kg
56.0 – 60.6kg
54.7 – 59.2kg
54.1 – 58.5kg
53.5 – 57.8kg
52.2 – 57.1kg
51.6 – 56.4kg
51.0 – 55.1kg
50.4 – 54.5kg
49.2 – 53.1kg
48.6 – 52.5kg
48.0 – 51.8kg
47.4 – 51.2kg
46.8 – 50.6kg
46.2 – 50.0kg
45.0 – 49.1kg
43.2 – 47.4kg
43.3 – 46.8kg
42.7 – 46.2kg
42.2 – 45.6kg
41.1 – 44.4kg
40.0 – 43.2kg
39.4 – 42.6kg
>72.2kg
>71.4kg
>70.7kg
>69.2kg
>68.5kg
>67.7kg
>66.2kg
>65.5kg
>64.8kg
>64.1kg
>63.4kg
>62.0kg
>61.3kg
>60.6kg
>59.2kg
>58.5kg
>57.8kg
>57.1kg
>56.4kg
>55.1kg
>54.5kg
>53.1kg
>52.5kg
>51.8kg
>51.2kg
>50.6kg
>50.0kg
>49.1kg
>47.4kg
>46.8kg
>46.2kg
>45.6kg
>44.4kg
>43.2kg
>42.6kg
Step 3: Acute disease effect
Add a score of 2 if there has been no or negligible dietary
intake for >5 days in the presence of an acute disease. If
not applicable score “0”.
30
32
34
36
38
40
42
44
46
48
50
52
54
56
58
60
62
64
66
68
70
72
74
76
78
80
82
84
86
88
90
92
94
96
98
100
Weight loss category
based on present weight (kg)
2
(>10%)
< = less than
1
(10-5%)
0
(<5%)
> more than
<27.0
<28.8
<30.6
<32.4
<34.2
<36.0
<37.8
<39.6
<41.4
<43.2
<45.0
<46.8
<48.6
<50.4
<52.2
<54.0
<55.8
<57.6
<59.4
<61.2
<63.0
<64.8
<66.6
<68.4
<70.2
<72.0
<73.8
<75.6
<77.4
<79.2
<81.0
<82.8
<84.6
<86.4
<88.2
<90.0
27.0 – 28.5
28.8 – 30.4
30.6 – 32.3
32.4 – 34.2
34.2 – 36.1
36.0 – 38.0
37.8 – 39.9
39.6 – 41.8
41.4 – 43.7
43.2 – 45.6
45.0 – 47.5
46.8 – 49.4
48.6 – 51.3
50.4 – 53.2
52.2 – 55.1
54.0 – 57.0
55.8 – 58.9
57.6 – 60.8
59.4 – 62.7
61.2 – 64.6
63.0 – 66.5
64.8 – 68.4
66.6 – 70.3
68.4 – 72.2
70.2 – 74.1
72.0 – 76.0
73.8 – 77.9
75.6 – 79.8
77.4 – 81.7
79.2 – 83.6
81.0 – 85.5
82.8 – 87.4
84.6 – 89.3
86.4 – 91.2
88.2 – 93.1
90.0 – 95.0
>28.5
>30.4
>32.3
>34.2
>36.1
>38.0
>39.9
>41.8
>43.7
>45.6
>47.5
>49.4
>51.3
>53.2
>55.1
>57.0
>58.9
>60.8
>62.7
>64.6
>66.5
>68.4
>70.3
>72.2
>74.1
>76.0
>77.9
>79.8
>81.7
>83.6
>85.5
>87.4
>89.3
>91.2
>93.1
>95.0
Subjective factors:
If you are unable to establish a risk using steps 1-3,
obtain an overall risk of the patient’s risk of
malnutrition using:
Step 1 - BMI: Clinical impression (very thin/thin) and
mid upper arm circumference <23.5cm.
Step 2 - Weight change: Clothes and/or jewellery
have become loose fitting, history of decreased food
intake, loss of appetite or swallowing problems over
3-6 months, underlying disease or psychosocial/physical
disabilities likely to cause weight loss.
Step 3 - Acute disease effect: No or negligible
nutritional intake for > 5 days in the presence of an
acute disease.
Step 4 - If a patient meets one or more of these criteria
they are likely to be a least moderate risk of
undernutrition.
Copyright © 2011 Darlington Primary Care Trust.
Developed by Rachael Masters of Darlington Primary Care Trust
2
www.focusonundernutrition.co.uk
Weight conversion chart
kg
st
lb
kg
st
lb
kg
st
lb
kg
st
lb
29.93
30.84
31.75
33.11
34.02
34.93
35.83
37.19
38.10
39.01
39.92
40.82
42.18
43.09
44.00
44.91
45.81
47.17
48.08
48.99
49.90
50.80
52.16
53.07
4
4
5
5
5
5
5
5
6
6
6
6
6
6
6
7
7
7
7
7
7
8
8
8
10
12
0
3
5
7
9
12
0
2
4
6
9
11
13
1
3
6
8
10
12
0
3
5
53.98
54.89
56.25
57.15
58.06
58.97
59.88
61.24
62.14
63.05
63.96
64.86
66.23
67.13
68.04
68.95
69.85
71.22
72.12
73.03
73.94
74.84
76.20
77.11
8
8
8
9
9
9
9
9
9
9
10
10
10
10
10
10
11
11
11
11
11
11
12
12
7
9
12
0
2
4
6
9
11
13
1
3
6
8
10
12
0
3
5
7
9
11
0
2
78.02
78.93
80.29
81.19
82.10
83.01
83.92
84.82
86.18
87.09
88.00
88.91
89.81
91.17
92.08
92.98
93.90
95.26
96.16
97.07
97.98
98.88
99.79
101.15
12
12
12
12
12
13
13
13
13
13
13
14
14
14
14
14
14
15
15
15
15
15
15
15
4
6
9
11
13
1
3
5
8
10
12
0
2
5
7
9
11
0
2
4
6
8
10
13
102.06
102.97
103.87
105.24
106.14
107.04
107.96
108.86
110.22
111.13
112.04
112.95
113.85
115.21
116.12
117.03
117.94
118.84
120.20
121.11
122.02
122.93
123.83
125.19
16
16
16
16
16
16
17
17
17
17
17
17
17
18
18
18
18
18
18
19
19
19
19
19
1
3
5
8
10
12
0
2
5
7
9
11
13
2
4
6
8
10
13
1
3
5
7
10
Height (metres)
Estimating height from ulna (Refer to Focus on Undernutrition guidelines on how to measure ulna)
Men (<65 years)
1.94 1.93 1.91
1.89
1.87
1.85
1.84 1.82
1.80
1.78 1.76 1.75
1.73
1.71
Men (>65 years)
1.87 1.86 1.84
1.82
1.81
1.79
1.78 1.76
1.75
1.73 1.71 1.70
1.68
1.67
Ulna length (cm)
32.0 31.5 31.0
30.5
30.0
29.5
29.0 28.5
28.0
27.5 27.0 26.5
26.0
25.5
Women (<65 years)
1.84 1.83 1.81
1.80
1.79
1.77
1.76 1.75
1.73
1.72 1.70 1.69
1.68
1.66
Women (>65 years)
1.84 1.83 1.81
1.79
1.78
1.76
1.75 1.73
1.71
1.70 1.68 1.66
1.65
1.63
Men (<65 years)
1.69 1.67 1.66
1.64
1.62
1.60
1.58 1.57
1.55
1.53 1.51 1.49
1.48
1.46
Men (>65 years)
1.65 1.63 1.62
1.60
1.59
1.57
1.56 1.54
1.52
1.51 1.49 1.48
1.46
1.45
Ulna length (cm)
25.0 24.5 24.0
23.5
23.0
22.5
22.0 21.5
21.0
20.5 20.0 19.5
19.0
18.5
Women (<65 years)
1.65 1.63 1.62
1.61
1.59
1.58
1.56 1.55
1.54
1.52 1.51 1.50
1.48
1.47
Women (>65 years)
1.61 1.60 1.58
1.56
1.55
1.53
1.52 1.50
1.48
1.47 1.45 1.44
1.42
1.40
Alternatively use the ‘MUST’ alternative measurement tape –
available from www.focusonundernutrition. co.uk
9h[Wj[Z_dfWhjd[hi^_fm_j^¼<eYkiedKdZ[hdkjh_j_ed½WdZfhel_Z[ZXo9ecfbWd<eeZiBjZš'.7k]kij(&&/šI_d]b[ki[edbo
Men(<65years)
1.94
1.93
1.91
1.89
1.87
1.85
1.84
1.82
1.80
1.78
1.76
1.75
1.73
1.71
1.69
1.67
1.66
1.64
1.62
1.60
1.58
1.57
1.55
1.53
1.51
1.49
1.48
1.46
HEIGHT(m)
Men(>65years)
1.87
1.86
1.84
1.82
1.81
1.79
1.78
1.76
1.75
1.73
1.71
1.70
1.68
1.67
1.65
1.63
1.62
1.60
1.59
1.57
1.56
1.54
1.52
1.51
1.49
1.48
1.46
1.45
Ulna length(cm)
32.0
31.5
31.0
30.5
30.0
29.5
29.0
28.5
28.0
27.5
27.0
26.5
26.0
25.5
25.0
24.5
24.0
23.5
23.0
22.5
22.0
21.5
21.0
20.5
20.0
19.5
19.0
18.5
HEIGHT(m)
Women(<65years)
1.84
1.83
1.81
1.80
1.79
1.77
1.76
1.75
1.73
1.72
1.70
1.69
1.68
1.66
1.65
1.63
1.62
1.61
1.59
1.58
1.56
1.55
1.54
1.52
1.51
1.50
1.48
1.47
HEIGHT(m)
Women(>65years)
1.84
1.83
1.81
1.79
1.78
1.76
1.75
1.73
1.71
1.70
1.68
1.66
1.65
1.63
1.61
1.60
1.58
1.56
1.55
1.53
1.52
1.50
1.48
1.47
1.45
1.44
1.42
1.40
The alternative measurements from the ‘Malnutrition Universal Screening Tool’ (‘MUST’) are reproduced here with the kind permission of BAPEN (British Association for Parenteral and Enteral Nutrition) www.bapen.org.uk. By granting copyright BAPEN does not necessarily support the use of Complan’s products.
*For further details on screening for undernutrition using ‘MUST’ refer to “The ‘MUST’ Explanatory Booklet”, which can be downloaded from www.bapen.org.uk/must_notes.html
Estimating Height from
Ulna Length
Using the tape on the reverse side,
measure between the point of the elbow
(olecranon process) and the midpoint of
the prominent bone of the wrist (styloid
process) (left side if possible). Find the
matching ulna length (red figures) in the
table to determine the subject’s height.
© BAPEN
Ulna / Height Conversion Table
HEIGHT(m)
Copyright © 2011 Darlington Primary Care Trust.
Developed by Rachael Masters of Darlington Primary Care Trust
www.focusonundernutrition.co.uk
3
Focus on Undernutrition nutritional assessment
To be completed annually. Implement a nutrition care plan for any section answered “YES”
1. Weight and appetite
Admission
Weight
Recent unintentional
weight loss during the
past 3 – 6 months
(If yes, ask normal weight)
Height
Poor fluid
intake - less
than 1500ml
fluid per day
o Yes
o No
o Unknown
Previous / normal weight ........................
Use ulna measurement to estimate height if resident is unable to stand.
o Yes
Preferred portion size
o No
Action: .......................................
....................................................
o Small
o Medium
o Large
Comments:
2. Dietary information
Special
dietary
needs
o No special dietary needs
o High protein, high energy foods
o Diabetes
Assistance
to eat and
drink
o Cardiac protective
Adapted
utensils
required?
o Independent
o Requires assistance
washing hands before
meal
o Requires assistance with
o Soft foods
positioning for meal
o Pureed foods
.................................
.................................
.................................
.................................
o Needs help cutting up
o Thickened fluids
food
o High fibre foods
o Needs full assistance
o Inform head cook of any special
requirements
o Religious needs, specify
........................................................
Preferred
temperature
of food and
drink
o Other, specify .................................
........................................................
.........................................................
o No
o Yes - specify:
o Prefers cold drinks
o Prefers hot drinks
o Prefers drinks served at room temperature
o Prefers cold foods
o Prefers hot foods
o Prefers foods served at room temperature
Food
dislikes
Food
likes
3. Eating environment
Preferred eating environment
Dining Room
Preferences regarding meals
Own Room
o Prefers specific table, specify: ...........................................................
Breakfast
o Requires specific seat for appropriate positioning, specify:
.............................................................................................................
o Prefers specific companions to eat with / carer to assist, specify:
.............................................................................................................
o Other preferences, specify: ...............................................................
Lunch
Tea
Supper
4. Swallowing and mouth care
Problems swallowing
/ chewing
o
Yes
o
No
Problems with mouth
or dentures
o
Yes
Special diets discussed with patient and family (date, time, what discussed and who with):
Additional comments on food and nutrition needs:
Copyright © 2011 Darlington Primary Care Trust.
Developed by Rachael Masters of Darlington Primary Care Trust
4
www.focusonundernutrition.co.uk
o
No