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
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
Mini 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, S.A., Vevey, Switzerland, Trademark Owners
© Nestlé, 1994, Revision 2009. N67200 12/99 10M
For more information: www.mna-elderly.com
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