The ‘malnutrition universal screening tool’ (‘MUST’) for adults has been developed for all health care settings and patient groups, but ease of use and agreement with other published tools when screening to identify malnutrition requires investigation. The present study assessed the agreement and the prevalence of malnutrition risk between ‘MUST’ and a variety of other tools in the same patients and compared the ease of using these tools. Groups of patients were consecutively screened using ‘MUST’ and: (1) MEREC Bulletin (MEREC) and Hickson and Hill (HH) tools (fifty gastroenterology outpatients); (2) nutrition risk score (NRS) and malnutrition screening tool (MST; seventy-five medical inpatients); (3) short-form mini nutritional assessment (MNA-tool; eighty-six elderly and eighty-five surgical inpatients); (4) subjective global assessment (SGA; fifty medical inpatients); (5) Doyle undernutrition risk score (URS; fifty-two surgical inpatients). Using ‘MUST’, the prevalence of malnutrition risk ranged from 19–60% in inpatients and 30% in outpatients. ‘MUST’ had ‘excellent’ agreement (κ 0.775–0.893) with MEREC, NRS and SGA tools, ‘fair–good’ agreement (κ 0.551–0.711) with HH, MST and MNA-tool tools and ‘poor’ agreement with the URS tool (κ 0.255). When categorisation of malnutrition risk differed between tools, it did not do so systematically, except between ‘MUST’ and MNA-tool (P=0.0005) and URS (P=0.039). ‘MUST’ and MST were the easiest, quickest tools to complete (3–5 min). The present investigation suggested a high prevalence of malnutrition in hospital inpatients and outpatients (19–60% with ‘MUST’) and ‘fair–good’ to ‘excellent’ agreement beyond chance between ‘MUST’ and most other tools studied. ‘MUST’ was quick and easy to use in these patient groups.

Malnutrition and its impact on clinical outcome may be underestimated in hospitalised elderly as many screening procedures require measurements of weight and height that cannot often be undertaken in sick elderly patients. The ‘Malnutrition Universal Screening Tool’ (‘MUST’)has been developed to screen all adults, even if weight and/or height cannot be measured, enabling more complete information on malnutrition prevalence and its impact on clinical outcome to be obtained. In the present study, 150 consecutively admitted elderly patients (age 85 (sd 5·5) years) were recruited prospectively, screened with ‘MUST’ and clinical outcome recorded. Although only 56% of patients could be weighed, all (n 150) could be screened with ‘MUST’; 58% were at malnutrition risk and these individuals had greater mortality (in-hospital and post-discharge, P<0·01) and longer hospital stays (P=0·02) than those at low risk. Both ‘MUST’ categorisation and component scores (BMI, weight loss, acute disease) were significantly related to mortality (P<0·03). Those patients with no measured or recalled weight (‘MUST’ subjective criteria used) had a greater risk of malnutrition (P<0·002) than those who could be weighed and, within both groups, clinical outcome was worse in those at risk of malnutrition. The present study suggests that ‘MUST’ predicts clinical outcome in hospitalised elderly, in whom malnutrition is common (58%). In those who cannot be weighed, a higher prevalence of malnutrition and associated poorer clinical outcome supports the importance of routine screening with a tool, like ‘MUST’, that can be used to screen all patients.

Nutritional support, including oral nutritional supplements, enteral tube feeding and parenteral nutrition, can be an important part of the management of any patient. Malnutrition is common and costly, clinically and financially, if left untreated. In patients with, or at risk of, malnutrition, the appropriate use of nutritional support can prevent complications arising, produce other clinical, functional and financial benefits, and can be life saving in some situations. This article discusses the evidence from systematic reviews and meta-analyses of the effectiveness of nutritional support.