Use of self-screening with MUST to identify IBD patients at risk of malnutrition

An evaluation of the feasibility and validity of a patient-administered malnutrition universal screening tool (‘MUST’) compared to healthcare professional screening in an inflammatory bowel disease (IBD) outpatient clinic

Keetarut et al., JHND Early View unknown-2


Malnutrition is common in inflammatory bowel disease (IBD) and is associated with poor health outcomes. Despite this, screening for malnutrition in the outpatient-setting is not routine and research in the area is limited. The present study aimed to evaluate whether agreement between malnutrition screening completed by patients and healthcare professionals (HCPs) could be achieved by comparing patient self-administered ‘MUST’ (‘MUST’-P) with HCP administered ‘MUST’ (‘MUST’-HCP) in a single tertiary IBD outpatient clinic.


We conducted a feasibility and validity study on adult outpatients with IBD. We collected anthropometric, nutritional and clinical data from patients. All patients completed ‘MUST’-P using a self-administered questionnaire, followed by ‘MUST’-HCP. ‘MUST’-P was timed and feedback on ease-of-use was obtained. The risk of malnutrition was classified as low (score = 0), medium (score = 1) and high (score ≥ 2) and agreement was tested using kappa statistics (κ).


Eighty patients were recruited (Crohn’s disease: = 49, ulcerative colitis: = 29, unclassified: = 2), with a mean (SD) age of 39.9 (15.1) years (51.2% were males). Seventy-one (92%) of patients found ‘MUST’-P either easy or very easy. The mean (SD) time to complete ‘MUST’-P was 3.1  (1.8) min (range 1–10 min). Sixty-eight (85%) of patients were at low risk of malnutrition when screened by the HCP. There was moderate agreement (κ = 0.486, < 0.001) between ‘MUST’-P and ‘MUST’-HCP, with 100% agreement in scoring for medium- and high-risk categories.


The results of the present study suggests that self-screening using ‘MUST’ could be effectively used in an IBD outpatient clinic to identify those at medium and high risk of malnutrition. The patient friendly version of ‘MUST’ (‘MUST’-P) was considered quick and easy to use by patients. Implementation of self-screening with ‘MUST’ could improve the nutritional management of IBD patients.


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