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Part II Nutrition Assessment, Consequences, and Implications Figure 7.1 Mini Nutritional Assessment

Mini Nutritional Assessment MNA®

Last name: Sex:

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

IF BMI IS NOT AVAILABLE, REPLACE QUESTION F1 WITH QUESTION F2. DO NOT ANSWER QUESTION F2 IF QUESTION F1 IS ALREADY COMPLETED.

F2 Calf circumference (CC) in cm 0 = CC less than 31 3 = CC 31 or greater

Screening score (max. 14 points)

12–14 points: 8–11 points: 0–7 points:

Normal nutritional status At risk of malnutrition Malnourished

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Source: Mini Nutritional Assessment, ®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.

First name: Age: Weight, kg:Height, cm: Date: