MUST — BAPEN 2003 BMI + Weight Loss + Acute Disease NRS-2002 · MNA-SF GLIM Criteria 2019 Hospital · Care Home · Community

Malnutrition
Universal
Screening

BAPEN MUST 5-step protocol · Alternative measurements · NRS-2002 & MNA-SF · GLIM mapping · Setting-specific care plans · ESPEN 2021 targets

3MUST Steps
3Care Settings
4Screening Tools
7Report Tabs
Jump to assessment
✓ BAPEN MUST 2003 ✓ NICE CG32 2006 ✓ NRS-2002 Kondrup 2003 ✓ MNA-SF Guigoz 2006 ✓ GLIM Cederholm 2019 ✓ ESPEN 2021 ✓ Chumlea 1988 · Bassey 1986

MUST Clinical Screening

Malnutrition Universal Screening Tool · All computations are local & private

MUST 3-step formula: BMI Score + Unplanned Weight Loss Score + Acute Disease Effect Score = Overall MUST Score → Risk category + setting-specific care plan. When standard measurements are unavailable, validated alternative methods (knee height, demi-span, MUAC) are provided at each step.
0Patient Context & Clinical Setting
yrs
Needed for height estimation formulas and MNA-SF (if ≥65 yrs).
⚠ Oedema/ascites causes weight/BMI to overestimate nutritional status. Use MUAC.
STEP 1
BMI Score
>20 = 0 pts  |  18.5–20 = 1 pt  |  <18.5 = 2 pts
—
cm
Remove shoes; stand against stadiometer. If unable, use alternatives below.
kg
Calibrated scales; light clothing; no shoes. If unable to stand, use hoist/chair scales.
Enter height & weight
STEP 2
Unplanned Weight Loss Score
<5% = 0 pts  |  5–10% = 1 pt  |  >10% = 2 pts
—
kg
Weight before illness/condition began. Use patient recall, carers, or previous records (last 3–6 months).
kg
Auto-filled from Step 1 weight if entered. Override if different measurement context.
Enter both weights
📋 Unplanned weight loss: Must be involuntary and not due to diuresis, oedema reduction, or intentional dieting. Time reference is 3–6 months preceding assessment. Longer-term weight loss (>6 months) is still clinically significant — document separately.
STEP 3
Acute Disease Effect
Acutely ill + no nutrition ≥5 days = 2 pts  |  Otherwise = 0 pts
—
Acute illness = physiological stress (ICU, sepsis, major surgery, acute GI condition, acute exacerbation of chronic disease, etc.).
ℹ Step 3 scores ONLY 0 or 2 — never 1. This step applies to ALL settings (hospital, community, care home) if the criterion is met. Typical acute-illness situations: critical illness (ICU), nil-by-mouth for surgery, severe dysphagia, acute bowel obstruction, chemotherapy-induced grade 3–4 mucositis, severe vomiting/diarrhoea preventing intake.

MUST = BMI Score + Unplanned Weight Loss Score + Acute Disease Effect Score · BAPEN 2003 · NICE CG32 · NRS-2002 Kondrup · MNA-SF Guigoz · GLIM Cederholm 2019 · ESPEN 2021

MUST SCORE
—
Enter values above
Step 1
BMI—
+
Step 2
Wt Loss—
+
Step 3
Acute—
=
MUST
Total—
MUST SCORING GUIDE
Step 1 — BMI
BMI >200 pts
BMI 18.5–201 pt
BMI <18.52 pts
Step 2 — Weight Loss (3–6 mo)
<5%0 pts
5–10%1 pt
>10%2 pts
Step 3 — Acute Disease
Not acutely ill0 pts
Ill + nil ≥5 days2 pts
Total MUST Score
0Low Risk
1Medium Risk
≥2High Risk
TOOLS INCLUDED
📋
MUST (BAPEN 2003)3-step malnutrition screening
📐
Alt. MeasurementsKnee ht · Demi-span · MUAC
🏥
NRS-2002Hospital nutritional risk screening
👴
MNA-SFElderly malnutrition screening
🌍
GLIM CriteriaGlobal diagnosis of malnutrition
🗺️
Setting Care PlansHospital · Care Home · Community
🎯
Nutrition TargetsESPEN 2021 energy & protein goals
📄
DocumentationClinical proforma & referral text
CLINICAL SUPPORT

Hospital Dietitian
Consultation

ESPEN 2021-aligned nutritional support protocols, ONS optimisation, and MUST monitoring from our clinical team.

Book Consultation →
CLINICAL DISCLAIMER
⚕ For qualified clinicians only

This tool is intended exclusively for use by registered dietitians, nurses, physicians, and other qualified healthcare professionals trained in nutritional screening. It is not suitable for use by patients or the general public without clinical supervision.

📋 Screening ≠ assessment

MUST is a malnutrition screening tool — not a comprehensive nutritional assessment. A positive screen (score ≥1) should trigger a full dietitian-led nutritional assessment. MUST identifies risk; formal diagnosis of malnutrition requires GLIM or equivalent assessment criteria.

⚖ Oedema and ascites

In patients with significant fluid retention (oedema, ascites, pleural effusion), BMI and body weight will overestimate true nutritional status. Use MUAC and clinical assessment. The actual risk may be substantially higher than the MUST score alone indicates.

🌍 Population applicability

MUST was primarily validated in UK adult hospital and community populations. Some thresholds (BMI, weight loss) may require adjustment for South Asian, East Asian, and other ethnic groups. GNRI and MNA-SF were validated in specific European elderly cohorts. Apply clinical judgement when using in paediatric (<18 yrs), pregnancy, or diverse ethnic populations.

📱 All calculations client-side

No patient data is transmitted, stored, or processed on any external server. All computations run locally in the browser. This tool does not constitute or replace a legal medical record.

Frequently Asked Questions — MUST Screening

What is the MUST (Malnutrition Universal Screening Tool)?

MUST is a 3-step malnutrition screening tool developed by BAPEN (Elia M., 2003) and validated in UK hospital, care home, and community settings (Stratton et al., Br J Nutr 2004). It combines a BMI score, an unplanned weight loss score, and an acute disease effect score into a total MUST score from 0 to 6, classifying patients as low, medium, or high nutritional risk.

How is the MUST score calculated?

MUST = BMI Score (0, 1, or 2) + Unplanned Weight Loss Score (0, 1, or 2) + Acute Disease Effect Score (0 or 2). Step 3 never scores 1 — it only applies when the patient is BOTH acutely ill AND has had no or minimal nutritional intake for 5 or more consecutive days. A total of 0 is low risk, 1 is medium risk, and 2 or more is high risk.

What does a MUST score of 2 or more mean?

A MUST score of 2 or more indicates high nutritional risk. Per BAPEN/NICE CG32, this requires immediate referral to a dietitian or nutrition support team, documented nutritional goals, and nutritional support initiated within 24–48 hours. Re-screening frequency depends on setting: weekly in hospital, monthly in care homes, and monthly in the community.

What if I can't measure height or weight directly?

MUST provides validated alternatives: knee height (Chumlea et al. 1988) or demi-span (Bassey 1986) can estimate height when a patient cannot stand; Mid Upper-Arm Circumference (MUAC) can substitute for BMI entirely when neither height nor weight can be obtained — MUAC below 23.5 cm corresponds to a BMI score of 2, while 23.5 cm or above scores 0.

How does oedema or ascites affect the MUST score?

Significant fluid retention (oedema, ascites, pleural effusion) causes weight and BMI to overestimate true nutritional status, so the MUST score may understate actual malnutrition risk. BAPEN recommends using MUAC and clinical assessment instead of weight-based BMI in these patients, and documenting the oedema/ascites in the patient's records.

How often should MUST be repeated?

Re-screening intervals depend on risk level and setting. Hospital: low risk weekly, medium risk weekly (observe 3-day intake), high risk weekly minimum. Care home: low risk monthly, medium risk monthly, high risk weekly initially then monthly. Community: low risk annually (every 3–6 months for high-risk groups), medium risk every 1–3 months, high risk monthly.

⚕ MUST validated across hospital, care home, and community settings in the UK (Stratton RJ et al. Br J Nutr 2004). NRS-2002 validated in 128 randomised clinical trials (Kondrup J et al. 2003). MNA-SF validated in 65+ elderly populations across 20+ countries. GLIM criteria endorsed by ESPEN, ASPEN, FELANPE, PENSA. All calculations client-side. Not for self-diagnosis. For use by qualified clinicians.