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The University of Southampton

Detecting and managing malnutrition: MUST

Research carried out at the University of Southampton has led to the development of a new tool for detecting and managing malnutrition in hospitals and clinics. The ‘Malnutrition Universal Screening Tool’ (MUST) - which uses a series of measurements for predicting and detecting malnutrition - is now integral to the UK’s health policy framework. It is used in over 80% of hospitals and care homes in England, and is now attracting significant international interest. Recognised by the National Institute for Health and Clinical Excellence (NICE) the MUST framework is has resulted in many millions of pounds of cost savings from the NHS.

Research Challenge

Malnutrition affects every system and tissue of the body and can result in an increased vulnerability to illnesses such as infections, longer hospital stays and increased chance of death. It is a very common clinical and public health problem in the UK, and affects as many as 30% of hospital patients and 35% of care home residents at a cost of more than £13 billion a year.


In the past malnutrition was frequently undiagnosed or underestimated. This is because the measurements needed for diagnosis have been hard to obtain in elderly and bed-bound patients, or because methods of measurement were labour intensive and impractical for routine use in hospitals or clinics. This has resulted in confused and poorly integrated care.

Our solution

Our researchers created and validated MUST for identifying and managing patients with, or at risk of, malnutrition. Over several years, our research has examined the relative merits of different types of measurements in identifying malnutrition. On the basis of our findings, we have been able to create MUST as a new method of predicting a variety of clinical outcomes. It has also been instrumental in identifying three simple risk indicators for malnutrition for infirm and non-communicative patients.

What is the impact?

Our research has been highly influential in informing national government and non-government initiatives as well as NICE and NHS-related bodies. Our MUST tool has benefited staff and patients, facilitated care between settings and enabled meaningful assessments of the burden of malnutrition.

Used in more than 80% of English care settings, the MUST framework achieves significant annual cost savings.

The Combating Malnutrition report was widely covered in national media including BBC News Online and The Guardian and recognised in the 2008 NHS Business Awards for ‘Innovation’. Further developments such as the MUST app for iphones are stimulating international demands for MUST.

Professor Marinos Elia develops the MUST App for the iPhone
Predicting malnutrition

Key Publications

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