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MUST (Malnutrition Universal Screening Tool)
MUST: A 5-step screening tool. Steps 1-3 generate the risk score. Steps 4-5 are the management guidelines based on the score. If BMI is unobtainable, use Mid-Upper Arm Circumference.
Complete Steps 1-3
Step 1: BMI Score
Step 2: Unplanned Weight Loss Score (past 3-6 months)
Step 3: Acute Disease Effect Score
Is the patient acutely ill and there has been or is likely to be no nutritional intake for > 5 days?
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Universal nutritional screening across all adult age groups, including older adults.
Standardised hospital admission screening mandated by many national health systems (e.g., NHS UK).
Community and care home settings to establish baseline nutritional risk.
Simplicity and Objectivity
The MUST relies heavily on objective anthropometric data (BMI and quantified weight loss) rather than subjective recall, making it highly reliable between different raters. It is less sensitive to early geriatric-specific malnutrition drivers than the MNA, but faster to apply broadly.
Section 2
Formula & Logic
Scoring
3 independent steps scored 0 to 2.
Total score: 0–6
0: Low risk
1: Medium risk
≥ 2: High risk
The 3 Steps
Step 1: BMI
> 20 (0), 18.5 - 20 (1), < 18.5 (2)
Step 2: Unplanned Weight Loss
< 5% (0), 5 - 10% (1), > 10% (2)
Step 3: Acute Disease
Acutely ill and no nutritional intake for > 5 days (Score 2)
Section 3
Pearls/Pitfalls
Alternatives for Missing Data
If height/weight cannot be obtained, MUST guidelines allow the use of Mid-Upper Arm Circumference (MUAC). MUAC <23.5 cm indicates BMI is likely <20 kg/m², triggering a high-risk nutritional protocol.
Section 4
Next Steps
Management
Section 5
Evidence Appraisal
Primary Reference
Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the "malnutrition universal screening tool" (MUST) for adults.
Stratton RJ et al. • Br J Nutr.. 2004;92(5):799-808. Validated the tool showing excellent inter-rater reliability and predictive validity for length of stay and mortality.
Section 6
Origins
BAPEN
Developed in 2003 by the Malnutrition Advisory Group of the British Association for Parenteral and Enteral Nutrition (BAPEN). It was created to provide a single, universal screening tool that could be used seamlessly across all care settings from community to ICU.
