Cited by 2,751Nutrition and Health in AgingBody Composition Measurement TechniquesClinical Nutrition and Gastroenterology

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Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini-Nutritional Assessment (MNA-SF)

Rubenstein, L. Z., Harker, J. O., Salva, A., Guigoz, Y., Vellas, B.·2001·The Journals of Gerontology Series A: Biological Sciences and Medical Sciences

DOI 10.1093/gerona/56.6.m366

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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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Influential
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Background
Identifying older people at risk of malnutrition and treatment in the community: prevalence and concurrent validation of the Patients Association Nutrition Checklist with ‘MUST’
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“Validated tools for use in community-living older adults include the ‘Malnutrition Universal Screening Tool’ (‘MUST’) ((15)), the Mini Nutritional Assessment Short Form (MNA-SF) ((16)), and the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN II) ((17)).”
Method
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“Moderate chronic malnutrition was defined as one or more criteria among: weight loss ≥5% in a month or ≥10% in 6 months, BMI 21 kg/m², albumin 35 g/L, MNA 17.”
Method
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“This study used the MNA-Short Form (28).”
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“The MNA-SF is a nutritional risk screening tool for older adults and ranges from 0 to 14 points, with a score of 11 or less indicating a nutritional risk [24].”
Background
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Kudelka, J., Ollenschläger, M., Dodel, R. C., Eskofier, B. M., Hobert, M. A., Jahn, K., Klucken, J., Labeit, B., Polidori, M. C., Prell, T., et al. (2024) · BMC Geriatrics · doi:10.1186/s12877-024-04913-6 · Cited by 20
“Sub-sequently, the S1 guideline for level 2 CGA specifically recommends the MNA-SF [37] as a brief instrument to assess the nutritional status, which was also frequently cited in our survey.”
BackgroundMethodInfluential
Texture modification of food for elderly people
Rothenberg, E. M., & Wendin, K. (2015) · Elsevier eBooks · doi:10.1016/b978-1-78242-334-8.00007-9 · Cited by 21
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“7%, respectively for predicting under-nutrition.(7) Kaiser et al.”
Background
Factors related to skeletal muscle mass in the frail elderly
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Validation (in Spanish) of the Mini Nutritional Assessment survey to assess the nutritional status of patients over 65 years of age
Díaz, B. M., Molina‐Recio, G., Romero‐Saldaña, M., Sánchez, J. R., Taberné, C. A., Blanco, C. A., Molina‐Luque, R., & de la Iglesia, J. M. (2018) · Family Practice · doi:10.1093/fampra/cmy051 · Cited by 19
“Subsequently, six questions of this questionnaire were selected to develop the short version of the MNA (MNA-SF), used as a screening method (8,9).”
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Severin, R., Berner, P. M., Miller, K. L., & Mey, J. (2019) · Topics in Geriatric Rehabilitation · doi:10.1097/tgr.0000000000000218 · Cited by 19
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Elevated Creatinine-Based Estimated Glomerular Filtration Rate is Associated with Increased Risk of Sarcopenia, Dysphagia, and Reduced Functional Recovery after Stroke
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Validation of the Japanese version of the Clinical Frailty Scale
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“The correlations of the CFS-J with other geriatric assessments (BI, Instrumental ADL [IADL], MNA-SF, MMSE, GDS-15, and Charlson Comorbidity Index [CCI]) were assessed by calculating the correlation coef ﬁ cients of the CFS-J with the BI, IADL, MNA-SF, MMSE, GDS-15, and CCI.”
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Home Monitoring System for Comprehensive Geriatric Assessment in Patient's Dwelling: System Design and UX Evaluation
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Preoperative frailty and one-year functional recovery in elderly cardiac surgery patients
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Nutritional and physical improvements in older adults through the DOREMI remote coaching approach: a real-world study
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“The MNA-SF is a nutritional screening tool scored on a 0–14 points scale, with higher scores indicating better nutritional status (Rubenstein et al., 2001).”
Background
Performance of 3 frailty scales for predicting adverse outcomes at 30 days in older patients discharged from emergency departments
Alonso, C. F., Galán, C. D. A., Gárate, R. T., Valdés, J. F. M., Pareja, R. R., Guillén, C. B., Miranda, B. R., Grinspan, M. S. R., Gabriel, S. G., Ubago, A. D. R., et al. (2024) · Emergencias · doi:10.55633/s3me/e062.2023 · Cited by 18
Comparison of the serum creatinine- and cystatin-C–based indices as screening biomarkers for sarcopenia in community-dwelling older adults
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Implementation of uHear™ - an iOS-based application to screen for hearing loss - in older patients with cancer undergoing a comprehensive geriatric assessment
Lycke, M., Boterberg, T., Martens, E., Ketelaars, L., Pottel, H., Lambrecht, A., Eygen, K. V., Coster, L. D., Dhooge, I. J. M., Wildiers, H. P. M. W., et al. (2016) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2016.01.008 · Cited by 18
“J Clin Oncol Off J Am Soc Clin Oncol 2011;29(25):3457–3465.”
Mini nutritional assessment short-form (MNA-SF) predicts institutionalisation in an intermediate post-acute care setting
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“Nutritional assessment was done using the Norwegian version of the six-item validated MNA-SF (16, 17).”
Malnutrition Rate In Stroke Patients On Admission
Çoban, E. (2018) · SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital · doi:10.14744/semb.2018.81994 · Cited by 18
“A screening score of ≤11 indicates possible malnutrition.[8] For stroke patients younger than 65 age, Nutrition Screening 2002 (NRS 2002) was used.”
Method
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Sena, G. R., Lima, T. P., de Mello, M. J. G., Thuler, L. C. S., & Lima, J. T. D. O. (2019) · JMIR Cancer · doi:10.2196/12163 · Cited by 18
“Comprises 6 questions on food intake, weight loss, mobility, psychological stress or acute disease, presence of dementia or depression, and body mass index Mini nutritional assessment-short form [20]”
Background
Sarcopenia is associated with severe erectile dysfunction in older adults: a population-based cohort study
Park, H., Jang, I., Han, M., Lee, H., Jung, H., Lee, E., & Kim, D. H. (2020) · The Korean Journal of Internal Medicine · doi:10.3904/kjim.2019.148 · Cited by 19
“A risk for malnutrition was defined as a Mini-Nutritional Assessment-Short Form score of ≤ 11 points [29].”
Method
Comparison of Three Frailty Scales for Prediction of Adverse Outcomes among Older Adults: A Prospective Cohort Study
Li, J., Jiang, S., Zhu, M., Liu, X. H., Sun, X., & Zhao, S. (2020) · The journal of nutrition health & aging · doi:10.1007/s12603-020-1534-x · Cited by 18
Malnutrition and Neurodegenerative Diseases
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Association between sarcopenia and erectile dysfunction in males with type II diabetes mellitus
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Psychosocial risk profiles among older adults living alone in South Korea: A latent profile analysis
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Nutritional status in the oldest elderly and associated factors
Boscatto, E. C., Duarte, M. D. F. D. S., Coqueiro, R. D. S., & Barbosa, A. R. (2013) · Revista da Associação Médica Brasileira (English Edition) · doi:10.1016/s2255-4823(13)70428-4 · Cited by 18
Factores asociados a mortalidad en nonagenarios. Estudio NonaSantfeliu. Seguimiento a los dos años
Formiga, F., Ferrer, A., Garrote, J. M. P.-C., Riera‐Mestre, A., Chivite, D., & Pujol, R. (2009) · Revista Clínica Española · doi:10.1016/s0014-2565(09)70352-2 · Cited by 18
Predictors of rapid cognitive decline among demented subjects aged 75 or more: (‘Sujet Agé Fragile—Evaluation et Suivi’ Cohort—SAFES)
Viatonou, S., Dramé, M., Jolly, D., Morrone, I., Lang, P. O., Voisin, T., Boyer, F. C., Schwebel, G., Somme, D., Blanchard, F., et al. (2009) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2183 · Cited by 18
Awareness of malnutrition in healthcare : the Dutch perspective
Meijers, J. M. M. (2009) · doi:10.26481/dis.20090702jm · Cited by 18
The Effects of Post-Acute Care in Patients with Heart Failure in Taiwan: A Single Center Experience.
Wang, P., Lin, W.-C., Hsieh, P.-C., Lin, S., Liu, P., Chao, T., & Hsu, C. (2023) · PubMed Central · doi:10.6515/acs.202303_39(2).20220923b · Cited by 17
Effectiveness of comprehensive geriatric assessment with extensive patient coaching for improving quality of life in older patients with solid tumours receiving systemic therapy (G-oncoCOACH): a multicentre randomised controlled trial
Kenis, C., Peeters, L., Laethem, L., Cock, J. D., Compté, N., Flamaing, J., Milisen, K., Fagard, K., Lobelle, J., Laenen, A., et al. (2025) · The Lancet Healthy Longevity · doi:10.1016/j.lanhl.2025.100743 · Cited by 17
Actividad ortogeriátrica en los hospitales públicos de Castilla y León: descripción y revisión de la literatura
Sáez-López, P., Pérez, E. M., Ramírez, A. G., Pablos‐Hernández, C., Mola, S. J., Vuelta-Calzada, E., Cerón-Fernández, A., Díaz, M., Tagarro, P. D. P., Andrés-Sainz, A. I., et al. (2014) · Revista Española de Geriatría y Gerontología · doi:10.1016/j.regg.2014.01.004 · Cited by 17
Readmission within three months after inpatient geriatric care—Incidence, diagnosis and associated factors in a Swedish cohort
Willers, C., Boström, A., Carlsson, L., Lager, A., Lindqvist, R., & Rydwik, E. (2021) · PLoS ONE · doi:10.1371/journal.pone.0248972 · Cited by 17
“Downton, Norton and MNA were modeled as binary variables based on previous research and cut-off levels used in clinical practice; high risk of fall (Downton�3 [27]), risk of developing pressure ulcer (Norton�20 [28]), and risk of malnutrition (MNA�11 [29]).”
Method
Late-onset neuromuscular disorders in the differential diagnosis of sarcopenia
Hofmeister, F., Baber, L., Ferrari, U., Hintze, S., Jarmusch, S., Krause, S., Meinke, P., Mehaffey, S., Neuerburg, C., Tangenelli, F., et al. (2021) · BMC Neurology · doi:10.1186/s12883-021-02264-y · Cited by 17
“Beside the SARCF questionnaire, the Instrumental Activities of Daily Life (IADL) andnutritional status by the Mini Nutritional Assessment in short form (MNA-SF) were applied [22, 23].”
Method
Developing a machine learning model to identify delirium risk in geriatric internal medicine inpatients
Li, Q., Zhao, Y., Chen, Y., Yue, J., & Xiong, Y. (2021) · European Geriatric Medicine · doi:10.1007/s41999-021-00562-9 · Cited by 17
Using the “Surprise Question” to Predict Frailty and Healthcare Outcomes among Older Adults Attending the Emergency Department
Gaffney, L., Jonsson, A., Judge, C. S., Costello, M. M., O’Donnell, J. J., & Ó’Caoimh, R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19031709 · Cited by 17
“A cut-off score of ≤11 identified those at risk f malnutrition [30].”
BackgroundMethodInfluential
Nutritional Needs in Mental Healthcare: Study Protocol of a Prospective Analytic Observational Study Assessing Nutritional Status, Eating Behavior and Barriers to Healthy Eating in Psychiatric Inpatients and Outpatients Compared to Healthy Adults
Hotzy, F., Risch, L., & Mötteli, S. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.906234 · Cited by 17
Nutrition mediates the relationship between number of teeth and sarcopenia: a pathway analysis
Xia, X., Xu, Z., Hu, F., Hou, L., Zhang, G., & Liu, X. (2022) · BMC Geriatrics · doi:10.1186/s12877-022-03350-7 · Cited by 17
“And MNA-SF scores from 0 ~ 7 indicated malnutrition status, 8 ~ 11 indicated malnutrition risk, 12 ~ 14 indicated good nutrition status [16].”
Background
Functional status in older patients with cancer and a frailty risk profile: A multicenter observational study
Meert, G., Kenis, C., Milisen, K., Debruyne, P. R., Groof, I. D., Focan, C., Cornélis, F., Verschaeve, V., Bachmann, C., Bron, D., et al. (2022) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2022.08.019 · Cited by 17

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.
ORCID: Rubenstein, L. Z.
Vellas, B.
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
DOI: 10.1093/gerona/56.6.m366
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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Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini-Nutritional Assessment (MNA-SF)

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