MUST Screening Guide
The Malnutrition Universal Screening Tool (MUST) is a five-step screening tool recommended by BAPEN for identifying adults who are at risk of malnutrition or who are already malnourished. Complete all three scoring steps then calculate the total to determine the management plan.
BMI Score
Calculate the resident's Body Mass Index (BMI) using their measured weight and height. If weight and height cannot be measured, use alternative measures (mid-upper arm circumference) or clinical judgement.
BMI > 20.0 (overweight or normal weight)
BMI 18.5–20.0 (at risk of malnutrition borderline)
BMI < 18.5 (underweight — high risk of malnutrition)
Unplanned Weight Loss Score
Assess the percentage of unplanned weight loss in the last 3–6 months. This can be calculated from previous weight records. A loss of more than 5% in 3 months or 10% in 6 months is significant.
Weight loss < 5% in 3 months (or < 10% in 6 months)
Weight loss 5–10% in 3 months (or concern about weight loss but figures unavailable)
Weight loss > 10% in 3 months (significant malnutrition risk)
Acute Disease Effect Score
Assess whether the resident has an acute condition that has caused or is likely to cause no dietary intake for 5 or more days. Even if intake is reduced but patient is likely to be able to eat, this score may not apply. If no acute disease, score 0.
No acute disease effect or patient has been eating normally
Acute disease and no nutritional intake for 5+ days (or likely)
MUST Score Calculator
Enter each step score below to calculate the total MUST score and identify the appropriate risk category and management plan.
Risk Categories & Management Plans
Low Risk
- Routine care — continue normal dietary intake
- Weigh monthly (or weekly if clinical concern)
- Record weight and BMI on care plan
- Re-screen at least monthly or on clinical change
- Offer food and fluid of appropriate texture and temperature
- Document nutritional intake if concern arises
Medium Risk
- Observe and document food and fluid intake for 3 days
- Weigh weekly
- Encourage nutritious snacks and fortified drinks between meals
- Consider referral to dietitian for advice
- Set realistic target weight and review weekly
- Offer food preferences and choices
- Review in 1–2 weeks — if not improving, increase to high risk management
- Re-screen monthly
High Risk
- Refer to dietitian within 24–48 hours
- Treat underlying condition if possible (e.g., infection, medication side effects)
- Provide fortified food and supplements as prescribed
- Offer food little and often — 6 small meals/snacks rather than 3 large meals
- Record food and fluid intake accurately
- Weigh weekly
- Consider oral nutritional supplements (ONS) if prescribed
- Consider texture-modified diet if swallowing difficulties (IDDSI levels)
- Monitor closely — re-weigh weekly, adjust care plan accordingly
- Discuss with GP — consider medical investigations if cause unknown
- Re-screen weekly until improving
Key Principles
- 1.Screen all residents on admission and at least monthly thereafter — or more frequently if clinically indicated.
- 2.If you cannot obtain a BMI (e.g., resident unable to be weighed), use mid-upper arm circumference (MUAC) as an alternative, or use clinical judgement to assign a score.
- 3.Always document the MUST score, risk category, and management plan in the resident's care plan.
- 4.Refer to a dietitian for high-risk residents (score of 2+) within 24–48 hours.
- 5.MUST is a screening tool, not a diagnostic tool. A low score does not rule out malnutrition if clinical judgement suggests concern.
Authoritative Resources
Important Notice:The MUST guidance provided by Care Handbook is for reference only and does not replace professional clinical judgement. Always follow your organisation's policies and consult a registered dietitian or GP when making clinical decisions about nutritional care. BAPEN's MUST tool should be used in accordance with the official guidelines available at bapen.org.uk.