Complete the
screen by filling in the boxes with the appropriate numbers. Total the numbers for the final screening score.
IF BMI IS NO
T AVAILABLE, REPLACE QUESTION F1 WITH QUESTION F2.
DO NOT ANSWER QUESTION F2 IF QUESTION F1 IS ALREADY COMPLETED.
Ref.
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 Assess
ment (MNA-SF). J. Geront 2001;56A: M366-377.
Guigoz Y. The Mini-Nutritional Assessment (MNA
®
) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487.
Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment Short-Form (MNA®-SF): A practical tool for identification
of nutritional status. J Nutr Health Aging 2009; 13:782-788.
® Société des Produits Nestlé SA, Trademark Owners.
© Société des Produits Nestlé SA 1994, Revision 2009.
For more information: www.mna-elderly.com
F2 Calf circumference (CC) in cm
0 = CC less than 31
3 = CC 31 or greater
Screening score
(max. 14 points)
12-1
4 points:
Normal nutritional status
8-11 points: At risk of malnutrition
0-7 poin
ts:
Malnourished
Last name: First name:
Sex: Age: Weight, kg: Height, cm: Date:
Screening
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
B Weight loss during the last 3 months
0 = weight loss greater than 3 kg (6.6 lbs)
1 = does not know
2 = weight loss between 1 and 3 kg (2.2 and 6.6 lbs)
3 = no weight loss
C Mobility
0 = bed or chair bound
1 = able to get out of bed / chair but does not go out
2 = goes out
D Has suffered psychological stress or acute disease in the past 3 months?
0
= yes 2 = no
E Neuropsychological problems
0 = severe dementia or depression
1 = mild dementia
2 = no psychological problems
F1 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
MNA
®
Mini Nutritional Assessment
