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Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults

Published online by Cambridge University Press:  09 March 2007

Rebecca J. Stratton*
Affiliation:
Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Southampton, UK
Annemarie Hackston
Affiliation:
Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Southampton, UK
David Longmore
Affiliation:
Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Southampton, UK
Rod Dixon
Affiliation:
Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Southampton, UK
Sarah Price
Affiliation:
Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Southampton, UK
Mike Stroud
Affiliation:
Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Southampton, UK
Claire King
Affiliation:
Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Southampton, UK
Marinos Elia
Affiliation:
Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Southampton, UK
*
*Corresponding author: Dr Rebecca J. Stratton, fax +44 23 80794945, email, R.J.Stratton@soton.ac.uk
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Abstract

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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.

Type
Research Article
Copyright
Copyright © The Nutrition Society 2004

Footnotes

Some of the results have been presented as abstracts at meetings of the British Association for Parenteral and Enteral Nutrition (BAPEN) and the European Society of Parenteral and Enteral Nutrition (ESPEN). For more information and for a free download of the malnutrition universal screening tool and the explanatory booklet, see www.bapen.org.uk

References

Akner, G & Cederholm, T (2001) Treatment of protein–energy malnutrition in chronic nonmalignant disorders. Am J Clin Nutr 74 624.Google Scholar
ASPEN Board, of Clinical Directors (1987) Guidelines for the use of enteral nutrition in the adult patient. J Parenter Enteral Nutr 11, 435439.Google Scholar
British Dietetic Association (1999) Nutrition Screening Tools. Professional Development Committee Briefing Paper no. 9 Birmingham British Dietetic Association.Google Scholar
Cantor, AB (1996) Sample size calculations for Cohen's kappa. Psychol Methods 1, 150153.Google Scholar
Consumer's Association (1996) Malnourished inpatients: overlooked and undertreated. Drugs Ther Bull 34, 5760.Google Scholar
Consumer's Association (1999) Helping undernourished adults in the community. Drugs Ther Bull 37, 9395.Google Scholar
Correia, JR, Martins, CA & Amaral, TF (2003) Efficiency of MST – Malnutrition Screening Tool – in elderly hospitalised patients. Clin Nutr 22, Suppl. 1S10Google Scholar
Council of Europe (2002) Food and Nutritional Care in Hospitals: How to Prevent Undernutrition. Report and Recommendations of the Committee of Experts on Nutrition, Food Safety and Consumer ProtectionStrasbourg:Council of Europe Publishing.Google Scholar
Department of HealthDepartment of Health (2001) Essence of Care – Patient Focused Benchmarking for Healthcare Practitioners London: The Department of Health.Google Scholar
Detsky, AS, McLaughlin, JR, Baker, JP, Johnston, N, Whittaker, S, Mendelson, RA & Jeejeebhoy, KN (1987) What is subjective global assessment of nutritional status?. J Parenter Enteral Nutr 11, 813.Google Scholar
Doyle, MP, Barnes, E & Moloney, M (2000) The evaluation of an undernutrition risk score to be used by nursing staff in a teaching hospital to identify surgical patients at risk of malnutrition on admission: a pilot study. J Hum Nutr Diet 13, 433441.Google Scholar
Elia, M (2003) Screening for Malnutrition: A Multidisciplinary Responsibility. Development and Use of the ‘Malnutrition Universal Screening Tool’ (‘MUST’) for Adults. Malnutrition Advisory Group (MAG), a Standing Committee of BAPEN Redditch, Worcs BAPEN Chairman and EditorGoogle Scholar
Elia, M (2000) Guidelines for Detection and Management of Malnutrition in the Community. Malnutrition Advisory Group (MAG), Standing Committee of BAPEN Maidenhead, Berks BAPEN Chairman and EditorGoogle Scholar
Ferguson, M, Capra, S, Bauer, J & Banks, M (1999) Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition 15, 458464.Google Scholar
Hickson, M & Hill, M (1997) Implementing a nutritional assessment tool in the community: a report describing the process, audit and problems encountered. J Hum Nutr Diet 10, 373377.Google Scholar
King, CL, Elia, M, Stroud, MA & Stratton, RJ (2003) The predictive validity of the malnutrition universal screening tool (‘MUST’) with regard to mortality and length of stay in elderly inpatients. Clin Nutr 22 S4Google Scholar
Kondrup, J, Allison, SP, Elia, M, Vellas, B & Plauth, M (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr 22, 415421.Google Scholar
Landis, JR & Koch, GG (1977) The measurement of observer agreement for categorical data. Biometrics 33, 159174.Google Scholar
Lewis, SJ, Egger, M, Sylvester, PA & Thomas, S (2001) Early enteral feeding versus ‘nil by mouth’ after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. Br Med J 323, 773776.Google Scholar
Murphy, MC, Brooks, CN, New, SA & Lumbers, ML (2000) The use of the Mini-Nutritional Assessment (MNA) tool in elderly orthopaedic patients. Eur J Clin Nutr 54, 555562.Google Scholar
National, Prescribing Centre (1998) Oral nutritional support (part 1). MEREC Bull 9, 2528.Google Scholar
NHS, Quality & Improvement Scotland (2003) Clinical Standards. Food, Fluid and Nutritional Care in Hospitals Edinburgh: NHS Quality Improvement ScotlandGoogle Scholar
Potter, J, Langhorne, P & Roberts, M (1998) Routine protein energy supplementation in adults: systematic review. Br Med J 317, 495501.Google Scholar
Reilly, HM, Martineau, JK, Moran, A & Kennedy, H (1995) Nutritional screening – evaluation and implementation of a simple nutrition risk score. Clin Nutr 14, 269273.Google Scholar
Royal College, of Physicians & of London (2002) Nutrition and Patients. A Doctor's Responsibility. Report of a Working Party of the Royal College of Physicians London: Royal College of PhysiciansGoogle Scholar
Rubenstein, LZ, Harker, JO, Salva, A, Guigoz, Y & Vellas, B (2001) Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A 56, M366M372.Google Scholar
Shetty, PS & James, WPT (1994) Body mass index: a measure of chronic energy deficiency in adults FAO Food and Nutrition Paper no. 56 1 – 57 Rome FAOGoogle Scholar
Stratton, RJ, Dixon, R, Longmore, D, Stroud, M & Elia, M (2003 a) Effect of recalled weight and height on malnutrition risk. Clin Nutr 22, Suppl. 1S9Google Scholar
Stratton, RJ & Elia, M (2000) How much undernutrition is there in hospitals?. Br J Nutr 84, 257259.Google Scholar
Stratton, RJ, Green, CJ & Elia, M (2003 b) Disease-Related Malnutrition: An Evidence Based Approach to Treatment, Wallingford, Oxon: CAB International.Google Scholar
Stratton, RJ, Thompson, RL, Margetts, BM, Stroud, M, Jackson, AA & Elia, M (2002) Health care utilisation according to malnutrition risk in the elderly: an analysis of data from the National Diet and Nutrition Survey. Proc Nutr Soc 61, 20A.Google Scholar
Wood, C, Stubbs, S, Warwick, H, Dunnachie, A, Elia, M & Stratton, RJ (2004) Malnutrition risk and health care utilisation in orthopaedic patients. Proc Nutr Soc 63, 20AGoogle Scholar