Malnutrition Universal Screening Tool "MUST" - A Key Tool in Nutritional Care

One pivotal aspect of nutritional support, as endorsed by NICE guidelines (nice.org.uk) is the effective screening for malnutrition risk.

The Malnutrition Universal Screening Tool ‘MUST’ stands out as a cornerstone in this effort. Developed by the British Association for Parenteral and Enteral Nutrition (bapen.org.uk), MUST is designed to help healthcare professionals identify adults who are malnourished or at risk of malnutrition.

Nutrition powers the body's healing processes. Adequate nutritional intake supports immune function, tissue repair, and overall recovery. Malnutrition can lead to weakened immunity, delayed wound healing, and increased susceptibility to infections. It's a vicious cycle where illness can diminish appetite or nutrient absorption, and inadequate nutrition can further impair health

Recognising and addressing malnutrition is not just about improving health outcomes; it's about transforming patient care. Nutritional support can shorten hospital stays, reduce complications, and even decrease mortality rates.

The Vital Role of Good Nutrition in Wound Healing

When it comes to healing wounds, whether they are minor cuts or major surgical incisions, the role of good nutrition cannot be overstated. Proper nutrition is foundational to the body's ability to repair itself. Every phase of the wound healing process requires specific nutrients to ensure a swift and efficient recovery. Here are several reasons why good nutrition is critical in wound healing:

• Protein Powers Repair: Protein is the building block of tissue and muscle. During the healing process, the body needs increased amounts of protein to repair damaged tissues. A deficiency in protein can lead to slower wound healing, increased risk of infection, and poorer outcomes. Foods rich in high-quality protein include lean meats, poultry, fish, eggs, dairy products, legumes, and nuts.

• Vitamins and Minerals – The Healing Catalysts: Certain vitamins and minerals play specific roles in healing wounds. Vitamin C, for example, is essential for collagen formation, a crucial component of skin tissue. It also helps with the absorption of iron, another important nutrient for wound healing. Zinc plays a critical role in maintaining skin integrity and is involved in the process of cell division, necessary for repairing damaged tissues. Sources of these nutrients include citrus fruits, strawberries, bell peppers, spinach, and pumpkin seeds.

• Hydration – The Unsung Hero of Healing: Adequate hydration is often overlooked in the wound healing process. Water is essential for all cellular functions and plays a pivotal role in delivering nutrients to the wound site, as well as in the removal of waste products from cells. Keeping the body well-hydrated ensures that the skin remains supple and resilient, which is vital for wound healing.

• Energy Needs: Healing wounds requires energy, which comes from calories. Consuming an adequate amount of calories is necessary to fuel the healing process. However, it's essential to source these calories from nutritious foods rather than empty calories from sugar-laden and highly processed foods. A balanced diet rich in fruits, vegetables, whole grains, healthy fats, and lean proteins provides the energy needed for efficient wound healing. 

• Immune System Support: Good nutrition strengthens the immune system, enabling it to fight off potential infections at the wound site. Nutrient-dense foods packed with antioxidants, vitamins, and minerals support the body's immune response, protecting the wound from complications that could delay healing.

Nutrition: A Key Factor in Preventing Pressure Sores

Pressure sores, also known as bedsores or pressure ulcers, are injuries to the skin and underlying tissue resulting from prolonged pressure on the skin. They often occur in individuals who are bedridden, use a wheelchair, or are unable to change their position frequently. While various factors contribute to the development of pressure sores, nutrition plays a pivotal role in their prevention.

Here's why nutrition is so crucial:

• Maintaining Skin Integrity: Healthy skin is the first line of defence against pressure sores. Nutrients such as protein, vitamins A and C, and zinc are essential for maintaining skin health and integrity. Protein is crucial for skin repair and regeneration, while vitamin C is involved in collagen production, which strengthens the skin. Vitamin A aids in skin cell turnover, and zinc promotes wound healing. A diet lacking these nutrients can lead to weakened skin, making it more susceptible to damage and the development of pressure sores.

• Supporting Immune Function: A well-nourished body has a stronger immune system, which is vital in preventing infections that can complicate pressure sores. Nutrients like vitamins C, E, and B6, along with minerals such as selenium and zinc, play significant roles in supporting immune health. Ensuring an adequate intake of these nutrients can help protect the body against infections and aid in the prevention of pressure sores.

• Enhancing Blood Flow: Proper nutrition supports cardiovascular health and enhances blood flow, ensuring that oxygen and nutrients necessary for skin health and wound healing are efficiently delivered throughout the body. Omega-3 fatty acids, found in fish, flaxseeds, and walnuts, are known to improve blood circulation, which is crucial for preventing pressure sores.

• Managing Body Weight: Both undernutrition and obesity can increase the risk of developing pressure sores. Undernutrition can lead to muscle wasting and decreased padding over bony prominences, making the skin more vulnerable to pressure sores. On the other hand, obesity can increase the pressure on certain areas of the body. A balanced diet helps in maintaining an optimal body weight, reducing the risk of pressure sores.

History and Development of MUST

MUST was developed in the early 2000s as a practical response to the growing need for an easy-to-use, reliable screening tool for malnutrition. Recognising the prevalence of malnutrition in hospital and community settings and its impact on patient outcomes and healthcare costs, BAPEN aimed to create a tool that could be universally applied across care settings. The goal was to standardise the assessment of malnutrition risk, ensuring early identification and intervention.

How the MUST Works

The MUST is ingeniously simple, designed for quick application while maintaining accuracy and reliability. It assesses three key parameters:

• BMI (Body Mass Index): The first step in the MUST process is to calculate the patient’s BMI, a measure of weight in relation to height. A low BMI is a clear indicator of malnutrition risk.

• Unintentional Weight Loss: The second step assesses the percentage of unintentional weight loss, comparing the patient's current weight to their known weight at a previous time. This factor is critical as it indicates a recent deterioration in nutritional status.

• Acute Disease Effect: The final step considers the impact of acute disease on nutritional intake. If a patient is unable to meet their nutritional requirements due to illness (and has not received nutritional intake for more than 5 days), this is factored into their overall risk score.

Each component is scored, and the total score determines the patient's risk of malnutrition:

• A score of 0 indicates low risk.

• A score of 1 suggests medium risk.

• A score of 2 or more signals high risk.

The Relevance of MUST in Healthcare

MUST has become an invaluable tool in healthcare settings for several reasons:

• Universal Applicability: It can be used in various settings, including hospitals, primary care, and community care, making it versatile.

• Early Intervention: By facilitating early detection of malnutrition risk, MUST allows healthcare professionals to intervene sooner, potentially preventing further decline in nutritional status.

• Improved Patient Outcomes: Early nutritional intervention can lead to better recovery rates, reduced complication risks, and shorter hospital stays.

• Cost-Effectiveness: Identifying and addressing malnutrition early can significantly reduce healthcare costs associated with prolonged treatment and complications.

Conclusion

Adequate nutrition is paramount for both preventing illness and facilitating recovery in the event of illness. To ensure comprehensive care, healthcare providers must establish robust policies outlining the procedures for conducting nutritional assessments.

These assessments serve as crucial checkpoints before patients are referred to specialists, such as dieticians, ensuring timely intervention and tailored care plans. While the Malnutrition Universal Screening Tool (MUST) emerges as an exceptional aid in this process, it is important to remember that MUST is merely a tool and should never replace clinical judgement.

Despite its straightforward design, MUST enables early identification of malnutrition risk, empowering healthcare professionals to intervene effectively. By embracing MUST alongside clinical judgment, healthcare providers not only strengthen the foundation of healing but also uphold the principles of compassion and diligence integral to exemplary healthcare provision.

Author

Scott Harding-Lister

Scott is a qualified nurse and solicitor. He was a senior nurse within the NHS before leaving to pursue a career as a solicitor in City practices. In 2013 he set up Apex Health Associates and the expert witness practice has gone from strength to strength. Scott is a medico-legal expert, a nursing expert, and head of practice at Apex.