M How much fluid (water, juice, coffee, tea, milk...) is
consumed per day?
0.0 = less than 3 cups
0.5 = 3 to 5 cups
1.0 = more than 5 cups
Assessment (max. 16 points)
Screening score
Total Assessment (max. 30 points)
.
K Selected consumption markers for protein intake
At least one serving of dairy products
(milk, cheese, yoghurt) per day
Two or more servings of legumes
or eggs per week
Meat, fish or poultry every day
0.0 = if 0 or 1 yes
0.5 = if 2 yes
1.0 = if 3 yes
yes
.
Last name: First name:
Sex: Age: Weight, kg: Height, cm: Date:
Complete the screen by filling in the boxes with the appropriate numbers.
Add the numbers for the screen. If score is 11 or less, continue with the assessment to gain a Malnutrition Indicator Score.
Screening
Assessment
Malnutrition Indicator Score
24 to 30 points Normal nutritional status
17 to 23.5 points At risk of malnutrition
Less than 17 points Malnourished
L Consumes two or more servings of fruit or vegetables
per day?
0 = no 1 = yes
Q Mid-arm circumference (MAC) in cm
0.0 = MAC less than 21
0.5 = MAC 21 to 22
1.0 = MAC greater than 22
O Self view of nutritional status
0 = views self as being malnourished
1 = is uncertain of nutritional state
2 = views self as having no nutritional problem
P In comparison with other people of the same age, how does
the patient consider his / her health status?
0.0 = not as good
0.5 = does not know
1.0 = as good
2.0 = better
N Mode of feeding
0 = unable to eat without assistance
1 = self-fed with some difficulty
2 = self-fed without any problem
yes
no
no
no
J How many full meals does the patient eat daily?
0 = 1 meal
1 = 2 meals
2 = 3 meals
.
.
.
.
.
.
R Calf circumference (CC) in cm
0 = CC less than 31
1 = CC 31 or greater
I Pressure sores or skin ulcers
0 = yes 1 = no
H Takes more than 3 prescription drugs per day
0 = yes 1 = no
G Lives independently (not in nursing home or hospital)
1 = yes 0 = no
Screening score (subtotal max. 14 points)
12-14 points: Normal nutritional status
8-11 points: At risk of malnutrition
0-7 points: Malnourished
For a more in-depth assessment, continue with questions G-R
F Body Mass Index (BMI) = weight in kg / (height in m)
2
0 = BMI less than 19
1 = BMI 19 to less than 21
2 = BMI 21 to less than 23
3 = BMI 23 or greater
E Neuropsychological problems
0 = severe dementia or depression
1 = mild dementia
2 = no psychological problems
D Has suffered psychological stress or acute disease in the
past 3 months?
0 = yes 2 = no
C Mobility
0 = bed or chair bound
1 = able to get out of bed / chair but does not go out
2 = goes out
B Weight loss during the last 3 months
0 = weight loss greater than 3kg (6.6lbs)
1 = does not know
2 = weight loss between 1 and 3kg (2.2 and 6.6 lbs)
3 = no weight loss
A Has food intake declined over the past 3 months due to loss
of appetite, digestive problems, chewing or swallowing
difficulties?
0 = severe decrease in food intake
1 = moderate decrease in food intake
2 = no decrease in food intake
Mi
ni Nutritional Assessment
MNA
®
References
1.
2.
Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and
Challenges. J Nutr Health Aging. 2006; 10:456-465.
Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for
Undernutrition in Geriatric Practice: Developing the Short-Form Mini
Nutritional Assessment (MNA-SF). J. Geront. 2001; 56A: M366-377
3. Guigoz Y. The Mini-Nutritional Assessment (MNA
®
) Review of the Literature - What
does it tell us? J Nutr Health Aging. 2006; 10:466-487.
® Société des Produits Nestlé SA, Trademark Owners
© Société des Produits Nestlé SA 1994, Revision 2009.
For more information: www.mna-elderly.com
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