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Managing Malnutrition according to ‘MUST’

  • BMI Score
    > 20kg/m2 Score 0
    18.5 - 20kg/m2 Score 1
    < 18.5kg/m2 Score 2
  • Weight Loss Score

    Unplanned weight loss score
    in past 3-6 months

    <5% Score 0
    5 - 10% Score 1
    >10% Score 2
  • Acute disease effect score

    (unlikely to apply outside hospital)

    If patient is acutely ill & there has been or is likely to be no nutritional intake for more than 5 days

    Score 2

Total score 0-6

  • Low Risk - Score 0

    Low Risk - Score 0

    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

  • Medium Risk - Score 1

    Medium Risk - Score 1

    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'.

    Observe

  • High Risk - Score 2 or more

    High Risk - Score 2 or more

    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.

    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*

* Treat unless detrimental or no benefit is expected from nutritional support.

Download Managing Malnutrition According To Risk Category Using 'MUST'

Management of Malnutrition

In most cases malnutrition is a treatable condition that can be managed using first line dietary advice to optimise food intake and oral nutritional supplements (ONS)13.

Management of malnutrition should be linked to the level of malnutrition risk14.

For all individuals: (click on boxes below for information)

  • Record Risk
  • Record Details of Malnutrition Risk

    Include; details of screening (weight, previous weight, BMI), screening result, risk category or clinical judgement. Record actions taken to manage malnutrition risk.

  • Agree goals of intervention
  • Goal Setting

    Agree goals of intervention with individual/carer

    Goal Setting

    Set goals to assess the effectiveness of intervention e.g. prevent further weight loss, maintain nutritional status, optimise nutrient intake during acute illness, healing of wounds or pressure ulcers, improved mobility.

    Consider disease stage and treatment; adjust goals of intervention accordingly. For example nutritional interventions in some groups such as palliative care, patients undergoing cancer treatment, patients with progressive neurological conditions and those in advanced stages of illness may not result in improvements in nutritional status, but may provide a valuable support to slow decline in weight and function.

  • Monitor
  • Monitoring The Intervention

    Monitor progress against goals and modify intervention appropriately.

    Consider weight, strength, physical appearance, appetite, ability to perform activities of daily living compared with goals set.

    Frequency of monitoring depends on setting and treatment.

If appropriate treat the underlying cause of malnutrition.

Members of the multidisciplinary team including Dietitians, Occupational Therapists, Speech and Language Therapists, Community Matrons and Community Therapists may need to be involved according to an individual's clinical condition.

Management options can include good food, assistance with eating, addressing social issues, ensuring ability to shop (physical and financial) and prepare food, texture modification, dietary advice to maximise nutritional intake (also known as ‘food first’) and ONS to complement dietary strategies in order to support individuals to meet their nutritional requirements7.

For All Individuals

  • Consider whether dietetic assessment is indicated due to underlying illness e.g. diabetes, COPD.
  • Consider underlying symptoms and cause of malnutrition (e.g. nausea, infections) and treat if appropriate.
  • Agree goals of intervention with individual/carer and record details of the malnutrition risk.
  • Reassess individuals identified at risk as they move through care settings.

This section

Managing Malnutrition according to ‘MUST’ Dietary Advice Oral Nutritional Supplements (ONS)
BAPEN 'MUST' Calculator BAPEN 'MUST' App

BMI calculator




Weight loss calculator




Download full document Survey What the experts say

Contact us

If you would like to contact us regarding the malnutrition pathway materials and website please email: hilary@franklincoms.co.uk

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