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Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini-Nutritional Assessment (MNA-SF)
Abstract
BACKGROUND: The Mini-Nutritional Assessment (MNA) is a validated assessment instrument for nutritional problems, but its length limits its usefulness for screening. We sought to develop a screening version of this instrument, the MNA-SF, that retains good diagnostic accuracy. METHODS: We reanalyzed data from France that were used to develop the original MNA and combined these with data collected in Spain and New MEXICO: Of the 881 subjects with complete MNA data, 151 were from France, 400 were from Spain, and 330 were from New MEXICO: Independent ratings of clinical nutritional status were available for 142 of the French subjects. Overall, 73.8% were community dwelling, and mean age was 76.4 years. Items were chosen for the MNA-SF on the basis of item correlation with the total MNA score and with clinical nutritional status, internal consistency, reliability, completeness, and ease of administration. RESULTS: After testing multiple versions, we identified an optimal six-item MNA-SF total score ranging from 0 to 14. The cut-point score for MNA-SF was calculated using clinical nutritional status as the gold standard (n = 142) and using the total MNA score (n = 881). The MNA-SF was strongly correlated with the total MNA score (r = .945). Using an MNA-SF score of > or = 11 as normal, sensitivity was 97.9%, specificity was 100%, and diagnostic accuracy was 98.7% for predicting undernutrition. CONCLUSIONS: The MNA-SF can identify persons with undernutrition and can be used in a two-step screening process in which persons, identified as "at risk" on the MNA-SF, would receive additional assessment to confirm the diagnosis and plan interventions.
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“Three validated questionnaires were implemented to assess the older adult’s frailty status covering multiple health domains.”
From Embodied Conversational Agent Appearance for Health Assessment of Older Adults: Explorative Study (2020) · cites this paper as [23]
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MethodNutritional screening tools in daily clinical practice: the focus on cancer
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“minutes to be completed, albeit keeping the usefulness and accuracy of the full version (3).”
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Hamirudin, A. H., Charlton, K. E., & Walton, K. L. (2015) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2015.09.007 · Cited by 85
Kuroda, A., Tanaka, T., Hirano, H., Ohara, Y., Kikutani, T., Furuya, H., Obuchi, S. P., Kawai, H., Ishii, S., Akishita, M., et al. (2015) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2015.01.078 · Cited by 90
Association between Malnutrition and Quality of Life in Elderly Patients with Rheumatoid Arthritis
Tański, W., Wójciga, J., & Jankowska‐Polańska, B. (2021) · Nutrients · doi:10.3390/nu13041259 · Cited by 86
“Total MNA scores from both parts are used to identify patients with a normal nutritional status (≥24 points), at risk of malnutrition (17–23 points), and with proteincalorie malnutrition (<17 points) [28].”
MethodDent, E., Visvanathan, R., Piantadosi, C., & Chapman, I. M. (2012) · Journal of Nutrition in Gerontology and Geriatrics · doi:10.1080/21551197.2012.678214 · Cited by 85
“NSTs used in the identified studies were the MNA (43), the MNA-short form (SF) (44), MUST (36), the Determine Your Nutritional Health (Nutritional Screening Initiative, NSI) checklist, Geriatric Nutritional Risk Index (GNRI) (45), Nutritional Status Score (NSS) (46), Chinese Nutritional Screening Tool (CNS) (47), Birm…”
MethodRikkert, M. G. M. O., Verhey, F. R. J., Sijben, J., Bouwman, F. H., DAUTZENBERG, P. L. J., Lansink, M., Sipers, W. M. W. H., van Asselt, D. Z. B., van Hees, A. M. J., Stevens, M., et al. (2014) · Journal of Alzheimer s Disease · doi:10.3233/jad-131892 · Cited by 88
“Mini Nutritional Assessment: The MNA® questionnaire was used as a measure of nutritional status [19–21].”
Self-citationScreening for malnutrition in elderly acute medical patients: the usefulness of MNA-SF.
Ranhoff, A. H., Gjøen, A. U., & Mowé, M. (2005) · PubMed · Cited by 85
Nutritional supplementation and dietary advice in geriatric patients at risk of malnutrition
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Isenring, E. A., Bauer, J. D., Banks, M., & Gaskill, D. L. (2009) · Journal of Human Nutrition and Dietetics · doi:10.1111/j.1365-277x.2009.01008.x · Cited by 85
Shiozu, H., Higashijima, M., & Koga, T. (2015) · Journal of Physical Therapy Science · doi:10.1589/jpts.27.393 · Cited by 84
Edmans, J. A., Bradshaw, L. E., Gladman, J. R. F., Franklin, M. K., Berdunov, V., Elliott, R. A., & Conroy, S. (2013) · Age and Ageing · doi:10.1093/ageing/aft054 · Cited by 84
“Other baseline variables included: • age, gender, residential status; • comorbidity—Charlson comorbidity index [13], a comorbidity score derived from a weighted list of medical conditions; • prescribed medications; • frailty—study of osteoporotic fractures index (SOF) [14], a 3-point scale; • malnutrition risk assessm…”
BackgroundInfluentialNutritional assessment of community-dwelling older adults in rural Nepal
Ghimire, S., Baral, B. K., & Callahan, K. E. (2017) · PLoS ONE · doi:10.1371/journal.pone.0172052 · Cited by 84
Isautier, J., Bosnić, M., Yeung, S. S. Y., Trappenburg, M. C., Meskers, C. G. M., Phillips, A. C., & Maier, A. B. (2019) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2019.06.024 · Cited by 88
Trajectory and Correlation of Intrinsic Capacity and Frailty in a Beijing Elderly Community
Liu, S., Kang, L., Liu, X., Zhao, S., Wang, X., Li, J. J., & Jiang, S. (2021) · Frontiers in Medicine · doi:10.3389/fmed.2021.751586 · Cited by 82
Which screening method is appropriate for older cancer patients at risk for malnutrition?
Isenring, E. A., & Elia, M. (2015) · Nutrition · doi:10.1016/j.nut.2014.12.027 · Cited by 82
Evidence based practice guidelines for the nutritional management of cancer cachexia
Bauer, J. D., Ash, S., Davidson, W., Hill, J. M., Brown, T. E., Isenring, E. A., & Reeves, M. M. (2006) · Nutrition & Dietetics · doi:10.1111/j.1747-0080.2006.00099.x · Cited by 82
Yoshimura, K., Yamada, M., Kajiwara, Y., Nishiguchi, S., & Aoyama, T. (2012) · Aging & Mental Health · doi:10.1080/13607863.2012.743961 · Cited by 84
“Nutritional status was assessed with the MiniNutritional Assessment Short-Form (MNA-SF; Rubenstein et al., 2001).”
MethodYe, X.-J., Ji, Y., Ma, B., Huang, D., Chen, W., Pan, Z., Shen, X., Zhuang, C., & Yu, Z. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019750 · Cited by 81
“It contains six questions selected from MNA.15 These questions are about BMI, recent weight loss, change of appetite, mobility, psychological stress and neuropsychological problems.”
Cortes, R., Malih, N., Abbate, M., Fresneda, S., Yáñez, A. M., & Bennasar‐Veny, M. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.03.008 · Cited by 95
Association of the oral health impact profile with malnutrition risk in Spanish elders
Montoya, J. A. G., Ponce, G. G. P., Lara, I. S., Barrios‐Rodríguez, R., Llodrá, J. C., & Bravo, M. (2013) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2013.05.002 · Cited by 81
Alzahrani, S. H., & Alamri, S. H. (2017) · BMC Geriatrics · doi:10.1186/s12877-017-0527-z · Cited by 81
“2- Second: Patient’s nutritional status was evaluated using the most recent version of the short form of Mini Nutritional Assessment (MNA-SF) [13].”
MethodNutritional status and all-cause mortality in older adults with acute coronary syndrome
Tonet, E., Campo, G. C., Maietti, E., Formiga, F., Martínez‐Sellés, M., Pavasini, R., Biscaglia, S., Serenelli, M., Sanchís, J. M., Díez‐Villanueva, P., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2019.06.025 · Cited by 80
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DiMaria-Ghalili, R. A., & Amella, E. J. (2005) · AJN American Journal of Nursing · doi:10.1097/00000446-200503000-00020 · Cited by 80
Inclusion of frail elderly patients in clinical trials: Solutions to the problems
Hempenius, L., Slaets, J. P. J., Boelens, M., van Asselt, D. Z. B., de Bock, G. H., Wiggers, T., & van Leeuwen, B. L. (2012) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2012.08.004 · Cited by 80
Gillain, S., Dramé, M., Lekeu, F., Wojtasik, V., Ricour, C., Croisier, J., Salmon, E., & Petermans, J. (2016) · Aging Clinical and Experimental Research · doi:10.1007/s40520-015-0392-6 · Cited by 77
Inoue, T., Misu, S., Tanaka, T., Sakamoto, H., IWATA, K., Chuman, Y., & Ono, R. (2016) · Clinical Nutrition · doi:10.1016/j.clnu.2016.08.021 · Cited by 78
Metadata
- Authors
- Rubenstein, L. Z., Harker, J. O., Salva, A., Guigoz, Y., & Vellas, B.
- Affiliations
- University of California, Los Angeles (US)
- VA Sepulveda Ambulatory Care Center (US)
- Nestlé (Switzerland) (CH)
- Corresponding author
- Rubenstein, L. Z.
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2001-06-01
- Volume
- 56
- Issue
- 6
- Pages
- M366-M372
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- OpenAlex
- W2122613011
- Cited by
- 2,751
- References
- 14
- Citations by year
- 2026: 252 · 2025: 266 · 2024: 265 · 2023: 239 · 2022: 252 · 2021: 263 · 2020: 179 · 2019: 143 · 2018: 112 · 2017: 112 · 2016: 109 · 2015: 93 · 2014: 79 · 2013: 61 · 2012: 76
- FWCI
- 5.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Geriatric Research Education and Clinical Center
- VA Greater Los Angeles Healthcare System
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nutrition and Health in Aging
- Health Sciences › Medicine › Physiology (medical) › Body Composition Measurement Techniques
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- Mini Nutritional Assessment, undernutrition screening, nutritional assessment, older adults, elderly nutrition, screening tool development, diagnostic accuracy, two-stage screening
- MeSH terms
- Aged, Female, Geriatrics, Humans, Male, Mass Screening, Nutrition Disorders, Professional Practice, Nutrition Assessment, Discriminant Analysis
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