Malnutrition can be identified using a validated screening tool such as the ‘Malnutrition Universal Screening tool’ (‘MUST’)1. For 'MUST' see BAPEN or e-Guidelines websites.
MUST’ is a 5 step screening tool that can be used across care settings to identify adults who are malnourished or at risk of malnutrition. ‘MUST’ includes management guidelines and alternative measures when BMI cannot be obtained by measuring weight and height1.
Unplanned weight loss score in past 3-6 months
Acute disease effect score
If patient is acutely ill & there has been or is likely to be no nutritional intake for more than 5 days
Total score 0-6
Routine clinical care
Review/repeat screening monthly in care homes
Annually in community if BMI > 30kg/m2 (obese) treat according to local policy/national guidelines
Routine Clinical Care
Dietary advice to maximise nutritional intake. Record intake for 3 days, encourage small frequent meals and snacks, with high energy and protein food and fluids13.
Powdered nutritional supplements to be made up with water or milk are available13.
Review progress/repeat screening after 1-3 months according to clinical condition or sooner if the condition requires.
If improving continue until 'low risk'.
If deteriorating, consider treating as 'high risk'.
Prescribe oral nutritional supplements (ONS) and monitor.
On improvement, consider managing as ‘medium risk’.
If no improvement or more specialist support is required, refer to dietitian.
* Treat unless detrimental or no benefit is expected from nutritional support.
In the absence of height and weight (measured or recalled), the following subjective indicators** can be used collectively to identify individuals at risk of malnutrition1:
**For more guidance on the use of subjective criteria, see The ‘MUST’ explanatory booklet.
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