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Mini Nutritional Assessment (MNA®). The MNA® is a screening tool to help identify elderly persons who are malnourished or at risk of malnutrition.
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Print CMYK | Blue = C 100% / M 72% / B 18% | Green = C 80% / Y 90%
Mini Nutritional Assessment (MNA®)
The MNA® is a screening tool to help identify elderly persons who are malnourished or at risk of malnutrition. This User Guide will assist you in completing the full MNA® accurately and consistently. It explains how the full MNA® and the MNA®-SF differ, how to complete each question and how to assign and interpret the score.
Introduction:
While the prevalence of malnutrition in the free-living elderly population is relatively low, the risk of malnutrition increases dramatically in the institutionalized and hospitalized elderly.^1 The prevalence of malnutrition is even higher in cognitively impaired elderly individuals and is associated with cognitive decline.^2
Patients who are malnourished when admitted to the hospital tend to have longer hospital stays, experience more complications, and have greater risks of morbidity and mortality than those whose nutritional state is normal.^3 By identifying elderly persons who are malnourished or at risk of malnutrition either in the hospital or community setting, the MNA® allows clinicians to intervene earlier to provide adequate nutritional support, prevent further deterioration, and improve patient outcomes.^4
Full MNA® vs. MNA®-SF
The full MNA® is a validated screening tool that identifies elderly persons who are malnourished or at risk for malnutrition. The full MNA® is the original version of the MNA® and takes 10-15 minutes to complete. The revised MNA®-SF is a short form of the MNA® that takes less than 5 minutes to complete. It retains the accuracy and validity of the full MNA®.^5 Currently, the MNA®-SF is the preferred form of the MNA® for clinical practice in community, hospital, or long term care settings, due to its ease of use and practicality.
The full MNA® is an excellent tool for the research setting. It may provide additional information about the causes of malnutrition in persons identified as malnourished or at risk for malnutrition. However, the full MNA® is not a substitute for a full nutritional assessment done by a trained nutrition professional. Recommended intervals for screening with the MNA® are annually in the community, every three months in institutional settings or in persons who have been identified as malnourished or at risk for malnutrition, and whenever a change in clinical condition occurs.
The MNA® was developed by Nestlé and leading international geriatricians. Well validated in international studies in a variety of settings6-8, the MNA® correlates with morbidity and mortality.
Instructions to complete the MNA®
Enter the patient’s information on the top of the form:
Involuntary weight loss during the last 3 months? Score 0 = Weight loss greater than 3 kg (6.6 pounds) 1 = Does not know 2 = Weight loss between 1 and 3 kg (2.2 and 6.6 pounds) 3 = No weight loss
Ask patient / Review medical record (if long term or residential care)
- “Have you lost any weight without trying _over the last 3 months?”
Has the patient suffered psychological stress or acute disease in the past three months? Score 0 = Yes 2 = No
Ask patient / Review medical record / Use professional judgment
_- “Have you been stressed recently?”
Mobility? Score 0 = Bed or chair bound 1 = Able to get out of bed/chair, but does not go out 2 = Goes out
Ask patient / Patient’s medical record / Information from caregiver
- “How would you describe your current _mobility?”
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Neuropsychological problems?
Score 0 = Severe dementia or depression 1 = Mild dementia 2 = No psychological problems
Review patient medical record / Use professional judgment / Ask patient, nursing staff or caregiver
_- “Do you have dementia?”
Body mass index (BMI)? (weight in kg / height in m^2 ) Score 0 = BMI less than 19 1 = BMI 19 to less than 21 2 = BMI 21 to less than 23 3 = BMI 23 or greater
Determining BMI BMI is used as an indicator of appropriate weight for height (Appendix 1) BMI Formula – US Units
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Lives independently (not in a nursing home)? Score 1 = Yes 0 = No
Ask patient This question refers to the normal living conditions of the individual. Its purpose is to determine if the person is usually dependent on others for care. For example, if the patient is in the hospital because of an accident or acute illness, where does the patient normally live?
- “Do you normally live in your own home, or in an assisted living, residential setting, or nursing home?”
Takes more than 3 prescription drugs per day? Score 0 = Yes 1 = No
Ask patient / Review patient’s medical record Check the patient’s medication record / ask nursing staff / ask doctor / ask patient
Pressure sores or skin ulcers? Score 0 = Yes 1 = No
Ask patient / Review patient’s medical record
- “Do you have bed sores?” Check the patient’s medical record for documentation of pressure wounds or skin ulcers, or ask the caregiver / nursing staff / doctor for details, or examine the patient if information is not available in the medical record.
How many full meals does the patient eat daily? Score 0 = One meal 1 = Two meals 2 = Three meals
Ask patient / Check food intake record if necessary
- “Do you normally eat breakfast, lunch and _dinner?”
Selected consumption markers for protein intake Select all that apply.
- At least one serving of dairy products (milk, cheese, yogurt) per day? _Yes No
Score 0.0 = if 0 or 1 Yes answer 0.5 = if 2 Yes answers 1.0 = if 3 Yes answers
Ask the patient or nursing staff, or check the completed food intake record
- “Do you consume any dairy products (a glass of milk / cheese in a sandwich / cup of yogurt / can of high protein supplement) _every day?”
Self-View of Nutritional Status
Score 0 = Views self as being malnourished 1 = Is uncertain of nutritional state 2 = Views self as having no nutritional problems
Ask the patient
- “How would you describe your nutritional state?” Then prompt ”Poorly nourished?” “Uncertain?” “No problems?” The answer to this question depends upon the patient’s state of mind. If you think the patient is not capable of answering the question, ask the caregiver / nursing staff for their opinion.
In comparison with other people of the same age, how does the patient consider his/her health status? Score 0.0 = Not as good 0.5 = Does not know 1.0 = As good 2.0 = Better
Ask patient
Again, the answer will depend upon the state of mind of the person answering the question.
Mid-arm circumference (MAC) in cm Score 0.0 = MAC less than 21 0.5 = MAC 21 to 22
1.0 = MAC 22 or greater
Measure the mid-arm circumference in cm as described in Appendix 4.
Calf circumference (CC) in cm Score 0 = CC less than 31 1 = CC 31 or greater
Calf circumference should be measured in cm as described in Appendix 5.
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Final Score
Intervention and Monitoring
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Appendix 1 Appendix 1 • Body Mass Index table
This abbreviated BMI table is provided for your convenience and facilitates completing the MNA®. It is accurate for the MNA®. In some cases, calculating the BMI may yield a more precise BMI determination.
Weight (pounds)
Weight (kg)
MNA® BMI Table for the Elderly (age 65 and above) Height (feet & inches) 4’11” 5’0” 5’1” 5’2” 5’3” 5’4” 5’5” 5’6” 5’7” 5’8” 5’9” 5’10” 5’11” 6’0” 6’1” 6’2” 6’3” 45 20 20 19 18 18 17 17 16 16 15 15 14 14 14 13 13 13 100 48 21 21 20 19 19 18 17 17 16 16 16 15 15 14 14 14 13 105 50 22 22 21 20 20 19 18 18 17 17 16 16 15 15 15 14 14 110 52 23 23 22 21 20 20 19 19 18 18 17 17 16 16 15 15 14 115 55 24 23 23 22 21 21 20 19 19 18 18 17 17 16 16 15 15 120 57 25 24 24 23 22 22 21 20 20 19 19 18 17 17 17 16 16 125 59 26 25 25 24 23 22 22 21 20 20 19 19 18 18 17 17 16 130 61 27 26 26 25 24 23 23 22 21 21 20 19 19 18 18 17 17 135 64 28 27 26 26 24 24 23 23 22 21 21 20 19 19 18 18 18 140 66 29 28 27 27 26 25 24 23 23 22 21 21 20 20 19 19 18 145 68 30 29 28 27 27 26 25 24 24 23 22 22 21 20 20 19 19 150 70 31 30 29 28 28 27 26 25 24 24 23 22 22 21 20 20 19 155 73 32 31 30 29 28 28 27 26 25 24 24 23 22 22 21 21 20 160 75 33 32 31 30 29 28 28 27 26 25 24 24 23 22 22 21 21 165 77 34 33 32 31 30 29 28 27 27 26 25 24 24 23 22 22 21 170 80 35 34 33 32 31 30 29 28 27 27 26 25 24 24 23 23 22 175 82 36 35 34 33 32 31 30 29 28 27 27 26 25 24 24 23 23 180 84 37 36 35 34 33 32 31 30 29 28 27 27 26 25 24 24 23 185 86 38 37 36 35 34 33 32 31 30 29 28 27 27 26 25 24 24 190 89 39 38 37 36 35 34 32 32 31 30 29 28 27 26 26 25 24 195 91 40 39 38 37 35 34 33 32 31 31 30 29 28 27 26 26 25 200 93 41 40 39 38 36 35 34 33 32 31 30 29 29 28 27 26 26 205 95 42 41 40 38 37 36 35 34 33 32 31 30 29 29 28 27 26 210 98 43 42 41 39 38 37 36 35 34 33 32 31 30 29 28 28 27 215 100 44 43 42 40 39 38 37 36 35 34 33 32 31 30 29 28 28 220 102 45 44 43 41 40 39 37 36 35 34 33 32 31 31 30 29 28 225 105 47 45 44 42 41 40 38 37 36 35 34 33 32 31 30 30 29 230 107 48 46 44 43 42 40 39 38 37 36 35 34 33 32 31 30 29 234 109 48 47 45 44 43 41 40 39 38 37 35 34 34 33 32 31 30 240 111 49 48 46 45 43 42 41 40 38 37 36 35 34 33 32 32 31 245 114 51 49 48 46 44 43 42 40 39 38 37 36 35 34 33 32 32 250 150 152.5 155 157.5 160 162.5 165 167.5 170 172.5 175 177.5 180 182.5 185 188 190 Height (cm)
Appendix 2 • Ways of Measuring Height
Demispan is the distance from the midline at the sternal notch to the web between the middle and ring fingers along outstretched arm. Height is then calculated from a standard formula.^9
Calculate height from the formula below: Females Height in cm = (1.35 x demispan in cm) + 60. Males Height in cm = (1.40 x demispan in cm) + 57.
Demi-span
2.2 • Measuring height using demispan
2.1 • Measuring height using a stadiometer
Accessed at: http://www.ktl.fi/publications/ehrm/product2/part_iii5.htm Accessed January 15, 2011.
Source: Reproduced here with the kind permission of BAPEN ( British Association for Parenteral and Enteral Nutrition ) from the ‘MUST’ Explanatory Booklet. For further information see www.bapen.org.uk (http://www.bapen.org.uk/pdfs/must/must_explan.pdf)
Knee height is one method used to determine statue in the bed- or chair-bound patient and is measured using a sliding knee height caliper. The patient must be able to bend both the knee and the ankle of one leg to 90 degree angles.
2.4 • Measuring height using knee height
Using population-specific formula, calculate height from standard formula: Population and Gender group
Equation: Stature (cm) = Non-Hispanic white men (U.S.) 11 [SEE = 3.74 cm]
78.31 + (1.94 x knee height)
79.69 + (1.85 x knee height)
82.77 + (1.83 x knee height)
82.21 + (1.85 x knee height)
89.58 + (1.61 x knee height)
84.25 + (1.82 x knee height)
85.10 + (1.73 x knee height)
91.45 + (1.53 x knee height)
94.87 + (1.58 x knee height)
94.87 + (1.58 x knee height)
74.7 + (2.07 x knee height)
67.00 + (2.2 x knee height)
73.70 + (1.99 x knee height)
Filipino Men^16 96.50 + (1.38 x knee height)– (0.08 x age)
Filipino Women^16 89.63 + (1.53 x knee height)– (0.17 x age)
Malaysian men 17 [SEE = 3.51 cm]
(1.924 x knee height)
Malaysian women 17 [SEE = 3.40]
(2.225 x knee height)
SEE = Standard Error of Estimate^11
Source: http://www.rxkinetics.com/height_estimate.html. Accessed January 15, 2011.
Screen and intervene. Nutrition can make a difference. 17
To determine the BMI for amputees, first determine the patient’s estimated weight including the weight of the missing body part.18,
Appendix 3 • Determining BMI for Amputees
Example: 80 year old man, amputation of the left lower leg, 1.72 m, 58 kg
61.6 ÷ [1.72 x 1.72] = 20.
Weight of selected body components It is necessary to account for the missing body component(s) when estimating IBW. Table: Percent of Body Weight Contributed by Specific Body Parts Body Part Percentage Trunk w/o limbs 50. Hand 0. Forearm with hand 2. Forearm without hand 1. Upper arm 2. Entire arm 5. Foot 1. Lower leg with foot 5. Lower leg without foot 4. Thigh 10. Entire leg 16.
References cited: Lefton, J., Malone A. Anthropometric Assessment. In Charney P, Malone A, eds. ADA Pocket Guide to Nutrition Assessment, 2nd^ edition. Chicago, IL: American Dietetic Association; 2009:160-161. Osterkamp LK., Current perspective on assessment of human body proportions of relevance to amputees, J Am Diet Assoc. 1995; 95 :215-218.
Screen and intervene. Nutrition can make a difference. 19
Print CMYK | Blue = C 100% / M 72% / B 18% | Green = C 80% / Y 90%
Screen and intervene.
Nutrition can make a difference.