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Purpose
The Mini-Nutritional Assessment (MNA) is an 18-item screening tool used to identify older adults (> 65 years) who are malnourished or at risk of malnutrition.
Link to Instrument
Acronym
MNA
Primary Image
Mini Nutritional Assessment
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Populations
Key Descriptions
- 2 variations: Long Form MNA and Short Form MNA-SF; current summary focuses upon the Long Form MNA
- 18-item (Long Form MNA) and 6-item (Short Form MNA-SF) questionnaire instrument
- Questionnaire instrument; Screening Tool
- Item scores are summed
- Nourishment levels range from malnutrition (less than 17), risk of malnutrition (17-23.5), normal nutritional status (24-30)
- Questions are weighted, 2-3 points per item
- Max score = 30
- Long Form MNA and Short Form MNA-SF versions included in this summary; Australian, Brazilian, English, Iranian, and Norwegian
- Long Form MNA interactive version is available in Bosnian, Dutch, English, Norwegian, and Thai.
- MNA-SF includes 33 versions; Bengali, Bosnian, Chinese, Croatian, Czech, Dutch, English, Farsi, Finnish, French, German, Greek, Hindi, Hungarian, Indonesian, Italian, Japanese, Khmer, Korean, Lithuanian, Nepali, Norwegian, Portuguese, Polish, Romanian, Sinhala, Slovakian, Spanish, Swedish, Tagalog, Turkish, Thai, and Urdu
- Long Form MNA and Short Form MNA-SF are available as paper versions and interactive (electronic) versions
- For scoring forms and protocol: https://www.mna-elderly.com/mna_forms.html
Number of Items
18-item (Long Form MNA)
6-item (Short Form MNA-SF)
Equipment Required
- Mini Nutritional Assessment form
- Writing utensil
Time to Administer
10-15 minutes
Required Training
No TrainingAge Ranges
Older Adults
65 +
yearsInstrument Reviewers
Initially reviewed by Kayleigh Adrian, MS and Kelley Sky-Eagle, MS, RD, LD, CDE in 2018; additional review by Rachel Bond, BA in 2019.
ICF Domain
Body FunctionMeasurement Domain
General HealthConsiderations
- Accurate gathering of height and weight, to calculate BMI can be troublesome, especially for bedridden individuals (DiMaria-Ghalili & Amella, 2012).
- Lack of familiarity with using calf circumference (cc), if BMI cannot be calculated, can lead to reporting error (DiMaria-Ghalili & Amella, 2012).
- Some questions report food intake, so individuals receiving tube-feeding or parenteral nutrition should be monitored by a professional (DiMaria-Ghalili & Amella, 2012).
- Ethnicity has been recognized as a significant modifier in anthropometric measurements. The MNA or cut-off point for malnutrition may not be a good fit for Asian populations (Amirkalali et al., 2010).
Internal Consistency
Parkinson’s (65+): (Ghazi, Fereshtehnejad, Fard, Sadeghi, Shahidi, & Lokk, 2015; n = 143; mean age = 61.44 (10.47); Iranian sample)
- Persian Version: Adequate internal consistency (Cronbach’s Alpha = 0.70); Full MNA assessed
- Poor internal consistency (Cronbach’s Alpha = 0.66); Screening component only
- Poor internal consistency (Cronbach’s Alpha at 0.55); Assessment component only
Criterion Validity (Predictive/Concurrent)
Parkinson’s Disease (65+): (Ghazi et al., 2015; n = 143; mean age = 61.44 (10.47); Iranian sample)
- Adequate concurrent validity (r = 0.427); Correlation between weight and total MNA score
- Adequate criterion validity (area under curve (AUC) = 0.710); Discrimination correlation between total MNA score and chronic disease
- Adequate predictive validity (total MNA score cut-off 26; sensitivity = 58%)
- Adequate predictive validity (total MNA score cut-off 26; specificity = 82%)
Mixed Conditions
back to PopulationsTest/Retest Reliability
Institutionalized Elderly: (Bleda, Bolar, Pares, & Salva, 2002; n = 67; mean age = 79(9); Spanish sample)
- Excellent test-retest reliability (ICC = .89)
- Excellent test-retest reliability (Kappa index = .78)
Interrater/Intrarater Reliability
Community Dwelling Older Adults (65+): (Fossum, Terjesen, Ehrenberg, Ehnfors, & Soderhamn, 2009; n = 26; mean age = 86.2 (7.3); Norwegian sample)
- Norwegian Version: Excellent interrater reliability (r = 0.88)
Hospitalized Older Adults (65+): (Neumann, Miller, Daniels, Ahern, & Crotty, 2007; n = 38; median IQR age = 84 (78-88); Australian sample)
- Excellent interrater reliability (ICC = 0.83)
Internal Consistency
Older Adults (65+):
- (Bleda, Bolar, Pares, & Salva, 2002; n = 67; mean age = 79(9); Spanish sample) Excellent internal consistency (Cronbach’s Alpha = 0.83); 1st assessment
- (Bleda, Bolar, Pares, & Salva, 2002; n = 67; mean age = 79(9); Spanish sample) Adequate internal consistency (Cronbach’s Alpha = 0.74); 2nd assessment
- (Amirkalali, Sharifi, Fakhrzadeh, Mirarefin, Ghaderpanahi, & Larijani, 2010; n = 221; mean age = 78.1 (7.5); Iranian sample) Poor internal consistency (Cronbach’s Alpha = 0.61)
Criterion Validity (Predictive/Concurrent)
Older Adults (65+):
- Portuguese Version: (Machado, Coelho, & Veras, 2015; n = 344; mean age = 75.4 (9.4); Brazilian sample)
- Adequate concurrent validity (area under curve (AUC) = 0.832); Mid arm circumference only
- Adequate concurrent validity (AUC = 0.728); BMI only
- Adequate concurrent validity (AUC = 0.717); Body fat only
- Adequate concurrent validity (AUC = 0.776); Calf circumference only
- Correlation between MNA and patient’s view of personal nutrition status: (Amirkalali, Sharifi, Fakhrzadeh, Mirarefin, Ghaderpanahi, & Larijani, 2010; n = 221; mean age = 78.1 (7.5); Iranian sample)
- Poor concurrent validity (r = 0.3)
- Adequate concurrent validity (AUC = 0.8)
- Total body fat assessed only: (Neumann, Miller, Daniels, Ahern, & Crotty, 2007; n = 38; median IQR age = 84 (78-88); Australian sample)
- Adequate criterion validity (AUC = 0.74)
Construct Validity
Older Adults (65+):
- Convergent Validity:
- (Machado, Coelho, & Veras, 2015; n = 344; mean age = 75.4 (9.4); Brazilian sample):
- Adequate convergent validity with body mass index (r = 0.468)
- Adequate convergent validity with mid-arm circumference (r = 0.380)
- Adequate convergent validity with calf circumference (r = 0.430)
- Adequate convergent validity with weight loss (r = 0.512)
- (Amirkalali, Sharifi, Fakhrzadeh, Mirarefin, Ghaderpanahi, & Larijani, 2010; n = 221; mean age = 78.1 (7.5); Iranian sample) Adequate convergent validity with BMI (r= 0.46)
Community Dwelling Older Adults (65+): ((Fossum, Terjesen, Ehrenberg, Ehnfors, & Soderhamn, 2009; n = 26; mean age = 86.2 (7.3); Norwegian sample)
- Convergent validity of the MNA was calculated using presence of pressure ulcers, BMI, and unassisted food intake; no correlation coefficient (r) located within the study
RNs
Patients with expected higher nutritional status
n
MNA scores M (SD)
Patients with lower nutritional status
n
MNA scores M (SD)
P-value
Group 1
No pressure sores or skin ulcers
19
20.1 (4.5)
Pressures sores or skin ulcers
7
14..4 (8.6)
0.036
BMI≥23 kg/m²
12
21.4 (2.5)
BMI≥23 kg/m²
14
16.6 (6.4)
0.025
Unassisted food intake
24
19.9 (4.1)
Assisted food intake
2
6.3 (4.6)
0.001
Group 2
No pressure sores or skin ulcers
23
19.9 (3.9)
Pressures sores or skin ulcers
3
10.5 (9.4)
0.003
BMI≥23 kg/m²
12
21.8 (3.5)
BMI≥23 kg/m²
14
15.9 (6.9)
0.013
Unassisted food intake
23
20.0 (5.1)
Assisted food intake
3
8.2 (4.5)
0.001
Table shows construct validity of MNA® reflected in differences between total scores among patients (N=26) with expected higher or lower nutritional status screened by two groups of registered nurses (n=10)
Hospitalized Older Adults (70+): (Dent, Chapman, Piantadosi, & Visvanathan, 2017; n = 100; mean age = 85.2 (6.1))
- Excellent convergent validity between Long Form MNA and MNA-SF-BMI score (r = 0.87)
- Excellent convergent validity between Long Form MNA and MNA-SF-CC score (r = 0.90)
Mixed Conditions
back to PopulationsNormative Data
Gender:
- Women: (Neuman, Miller, Daniels, Ahern, & Crotty, 2007; n = 16; median IQR age = 84 (78-88); Australian sample).
At risk of malnutrition (<24/30)
n = 8
Well nourished (>24/30)
n = 8
P-value
Total
Bodyweight (kg)
52 (44-63)
67 (60-78)
0.04
61 (57-71)
eBMI (kg/m2)
21 (18-25)
28 (25-30)
0.01
25 (21-29)
Fat-free mass (kg)
36 (33-41)
37 (35-41)
0.72
36 (33-41)
Total body fat (kg)
11 (7-22)
29 (20-40)
<0.01
21 (10-30)
% Body fat
25 (16-36)
40 (34-46)
<0.01
36 (24-40)
Serum albumin (g/L)
34 (32-38)
30 (29-32)
0.05
32 (29-35)
- Men: (Neuman, Miller, Daniels, Ahern, & Crotty, 2007; n = 18; median IQR age = 84 (78-88); Australian sample).
At risk of malnutrition (<24/30) n = 11
Well nourished (>24/30) n = 7
P-value
Combined Total
Bodyweight (kg)
70 (67-79)
78 (70-83)
0.21
73 (68-81)
eBMI (kg/m2)
24 (22-27)
25 (24-29)
0.13
25 (23-27)
Fat-free mass (kg)
50 (47-53)
48 (43-53)
0.72
49 (45-53)
Total body fat (kg)
19 (14-24)
24 (20-28)
0.18
20 (15-27)
% Body fat
29 (23-26)
30 (28-36)
0.54
30 (23-36)
Serum albumin (g/L)
32 (27-33)
36 (35-39)
0.01
33 (29-36)
Internal Consistency
Healthy Individuals: (Ghazi et al., 2015; n = 467; mean age = 49.86 (14.04); Iranian sample)
- Persian Version: Poor internal consistency (Cronbach’s Alpha = 0.66)
- Poor internal consistency (Cronbach’s Alpha at 0.51); Screening component only
- Poor internal consistency (Cronbach’s Alpha at 0.49); Assessment component only
Criterion Validity (Predictive/Concurrent)
Healthy Individuals: (Ghazi et al., 2015; n = 467; mean age = 49.86 (14.04); Iranian sample)
- Adequate criterion validity (AUC = 0.708); Discrimination correlation between total MNA score and chronic disease
- Adequate predictive validity (total MNA score cut-off 26; sensitivity = 69%)
- Adequate predictive validity (total MNA score cut-off 26; specificity = 60%)
Bibliography
Amirkalali, B., Sharifi, F., Fakhrzadeh, H., Mirarefin, M., Ghaderpanahi, M., & Larijani, B. (2010). Evaluation of the mini nutritional assessment in the elderly, Tehran, Iran. Journal of Public Health Nutrition, 13(9), 1373-1379. doi: 10.1017/S1368980010000303
Bleda, M. J., Bolibar, I., Pares, R., & Salva, A. (2002). Reliability of the mini nutritional assessment in institutionalized elderly people. The Journal of Nutrition, Health & Aging 6(2), pp. 134-137. Retrieved from http://www.mna-elderly.com/publications/167.pdf
Dent, E., Chapman, I., Piantadosi, C., & Visvanathan, R. (2017). Screening for malnutrition in hospitalised older people: Comparison of the mini nutritional assessment with its short-form versions. Australasian Journal on Ageing, 36(2), E8–E13. https://doi.org/10.1111/ajag.12402
DiMaria-Ghalili, R. M., Amella, E. J. (2012). Assessing nutrition in older adults. The Hartford Institute for Geriatric Nursing (9). Retrieved from https://consultgeri.org/try-this/general-assessment/issue-9.pdf
Fossum M, Terjesen S, Ehrenberg A, Ehnfors M, & Söderhamn O. (2009). Evaluation of the norwegian version of the mini nutritional assessment among older nursing home patients. Nordic Journal of Nursing Research & Clinical Studies/Vård i Norden, 29(2), 50–52. Retrieved from https://ezproxy.uindy.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=105395051&site=ehost-live
Ghazi, L., Fereshtehnejad, S. M., Fard, S. A., Sadeghi, M., Shahidi, G. A., Lokk, J. (2015). Mini nutritional assessment is rather a reliable and valid instrument to assess nutritional status in Iranian healthy adults and elderly with a chronic disease. Ecology of Food and Nutrition, 54(4), 342-357. doi: 10.1080/03670244.2014.994743
Machado, R. S. P., Coelho, M. A. S. C., & Veras, R. P. (2015). Validity of the portuguese version of the mini nutritional assessment in brazilian elderly. BMC Geriatrics, 15, 132. https://doi.org/10.1186/s12877-015-0129-6
Neumann, S. A., Miller, M. D., Daniels, L. A., Ahern, M., & Crotty, M. (2007). Mini nutritional assessment in geriatric rehabilitation: Inter-rater reliability and relationship to body composition and nutritional biochemistry. Nutrition and Dietetics, 64, 179-185. doi: 10.1111/j.1747-0080.2007.00146.x