Primary Image

Rehabilitation Measures Instrument

Mini Nutritional Assessment

Last Updated

Atomized Content

download

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. 

Acronym MNA

Area of Assessment

Eating

Assessment Type

Other

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

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 Training

Age Ranges

Older Adults

65 +

years

Instrument 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 Function

Measurement Domain

General Health

Considerations

  • 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).

Parkinson's Disease

back to Populations

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%)

Older Adults and Geriatric Care

back to Populations

Test/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)

Non-Specific Patient Population

back to Populations

Normative 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

Save now, read later.