Malnutrition is a common clinical and public health problem in England, which is found in all care settings, all disease categories, and individuals of all ages. Data captured from use of the Malnutrition Universal Screening Tool (MUST) estimates those who are affected by malnutrition in England:
At any point in time more than 3 million people in the UK are malnourished or at risk of malnutrition, most of these living in the community (~93 %). With an aging population the problem is expected to increase further since the prevalence of malnutrition increases with age. Since malnutrition can detrimentally affect the function of tissues within the body, it can predispose to a variety of diseases and adversely affect their clinical outcomes.
Malnutrition remains under-detected and under-treated in daily practice, and rates are significantly under-reported compared with national estimates.
The most commonly used screening tool is the ‘Malnutrition Universal Screening Tool (MUST)’. This is a validated screening tool formulated by the British Association for Parenteral and Enteral Nutrition (BAPEN), and is used throughout the NHS in Primary and Secondary care.
The National Institute for Health and Care Excellence (NICE) recommends that patients are screened within at least 24 hours of admission to hospital, and weekly thereafter. In the community, it is recommended that all patients are screened for malnutrition when they are registered with a new GP Practice and at all times when there are clinical concerns. Residents in Care Homes should be screened on admission and monthly thereafter. Screening should also occur on the transfer between Care Settings and an action plan and goal setting should be implemented in the new care environment. Other opportunities for screening include contact with district nurse, community matron, pharmacist, dietitian’s and other health professionals.
Once an individual has been identified as at risk of malnutrition, regular screening and monitoring is essential to determine any improvement or deterioration and action required. Frequency of screening is determined by the MUST risk category as per screening tool.