CHAPTER 59: MINI NUTRITIONAL ASSESSMENT—SHORT FORM (MNA-SF)

Description

The Mini Nutritional Assessment (MNA), by Vellas and Guigoz (1989), is a short nutrition-screening tool designed to help identify geriatric patients (65 years old and over) who are malnourished or at risk of malnutrition. The short form of the MNA (MNA-SF) consists of 6 questions that have shown to have high correlations with the original 18-item long form, which should be used if further investigations into the client’s condition are warranted after administration of the MNA-SF. Items on the assessment include an examination of (1) decline of food intake over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties; (2) weight loss during the last 3 months; (3) mobility; (4) psychological stress or acute disease in the past 3 months; (5) neuropsychological problems; and (6) body mass index (BMI), which is determined by solving weight in kg/height in m². The MNA-SF allows for the substitution of BMI, if it cannot be obtained, with calf circumference without losing validity. Each item of the MNA-SF is scored along a variable scale of 0 to 3 with total scores ranging from of 0 to 14. The assessment takes less than 10 minutes to complete with lower scores suggestive of poorer nutritional intake.

Psychometrics

A study of 881 subjects with a mean age of 76.4 years, 73.8% of which were community dwelling, determined that the MNA-SF had a sensitivity of 96%, specificity of 98%, and positive predictive value of 97% when using a score of ≥ 11 as normal cut point (Rubenstein, Harker, Salva, Guigoz, & Vellas, 2001). Using the MNA-SF in a study of nonagenarians (age 90 to 99 years old) found that 66.4% of the screened individuals were at risk of malnutrition (MNA-SF score ≤11) and risk of malnutrition was more prevalent in women than in men (68.9% vs 49.5%), while actual malnutrition, based on BMI, was observed in 21.9% of the participants and also tended to be higher in women than in men (22.9% vs 15.0%) (Vandewoude & Gossum, 2013). A study investigating the association between MNA-SF results and frailty status in community-dwelling older adults over 75 years old (n = 206) without cognitive impairment found 15.1% of the participants were at risk of malnutrition with no participant actually malnourished; however, 90% of those at risk of malnutrition were considered either pre-frail (15.5%) or frail (40%) (Bollwein et al., 2013). A population-based study of older adults (average age: 86 years) found that the mean MNA-SF score was 9.8, which is considered at risk, and that total MNA-SF scores were a significant predictor of mortality according to a Hazard Ratio, which is a measure of survival at any point in time in a group cohort, of 0.83 (Lilamand et al., 2015). Results also found that 198 (25.6%) presented with normal nutritional status (12 to 14 points), 454 (58.7%) were at risk of malnutrition (8 to 11 points), and 121 (15.7%) were malnourished and after 1 year of follow-up 135 (17.5%) had died (Lilamand et al., 2015).

Advantages

The MNA-SF has a significant amount of research in support of its use in clinical practice. The MNA-SF as well as the long version are considered gold standards of nutritional assessment and are utilized across many disciplines. No special training or certifications are needed and research has shown it to be a good predictor of feeding problems in those 65 years old and older. The Nestlé Nutrition Institute hosts an intuitive interactive website devoted to the MNA batteries which can be an excellent resource for the practitioner. Also, the scale has been well-validated in numerous cultural settings.

Disadvantages

The MNA-SF may be limited in its use as a quick screen only to suggest further testing if needed and should not necessarily be used to replace a full assessment if malnourishment is suspected. Finally, the MNA is only validated for patients over the age of 65 years old.

Administration

The MNA-SF is an interactive activity/questionnaire that is comprised of 6 items rated between 0 to 3 relative to aspects of subject’s nutritional intake. Scores can range from 0 to 14 with lower scores considered more problematic. A score of 0 to 7 suggests that the person is malnourished, 8 to 11 he or she is considered at risk, and 12 to 14 suggests normal nutritional status.

Permission

The MNA was developed by the Nestlé Nutrition Institute and is freely available to use in clinical practice. The MNA form is protected by copyright laws and is also a registered trademark of Société des Produits Nestlé S.A. By downloading the MNA form the user agrees to keep the original form unchanged. Permission to use the assessment for research or for commercial purposes can be obtained upon formal request. Further information about the MNA-SF can be found in the following article:

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