Purpose and History
The Mini Nutritional Assessment–Short Form (MNA-SF) is an abbreviated, and now preferred, version of the original 18-question Mini Nutritional Assessment (MNA) developed in the 1990s. Its creation was driven by the need for a faster, simpler, yet equally effective tool for screening large populations of older adults for malnutrition risk. The MNA-SF specifically targets individuals aged 65 and over and has been extensively validated in a variety of settings, including hospitals, nursing homes, and community clinics. Its purpose is to facilitate early detection, which is crucial for preventing further nutritional deterioration and improving overall patient outcomes.
The Six Screening Items
The MNA-SF is composed of six key screening criteria that can be completed in less than five minutes. The scores for each item are tallied to determine a person's nutritional status. The six items are:
- Food intake decline: Has the person’s food intake decreased over the past three months due to loss of appetite, digestive issues, or chewing/swallowing difficulties?
- Involuntary weight loss: Has the person experienced involuntary weight loss during the last three months?
- Mobility: Is the person bed- or chair-bound, able to get out but not go out, or does the person go out?
- Acute disease or psychological stress: Has the person suffered from acute disease or psychological stress in the past three months?
- Neuropsychological problems: Does the person have severe dementia, depression, or mild dementia, or no psychological problems?
- Body Mass Index (BMI): The tool incorporates BMI calculation or, if that is not possible for bedridden individuals, it allows for the use of a calf circumference measurement as a substitute.
How the MNA-SF is Scored
The total score on the MNA-SF ranges from 0 to 14, with higher scores indicating a better nutritional status. Based on the final score, an individual's nutritional status is categorized into one of three groups:
- Normal nutritional status (12–14 points): Individuals in this range are considered to have a normal nutritional status. They do not require further intervention, though periodic re-screening is recommended.
- At risk of malnutrition (8–11 points): This score indicates that the person is at risk of malnutrition. A more in-depth nutritional assessment is advised, and interventions may be necessary.
- Malnourished (0–7 points): A score in this range signals that the person is malnourished and requires immediate nutritional intervention and a comprehensive assessment.
Comparing the MNA-SF and Full MNA
| Feature | MNA-SF (Short Form) | Full MNA |
|---|---|---|
| Number of items | 6 | 18 |
| Time to complete | Less than 5 minutes | 10–15 minutes |
| Primary Use | Quick screening for malnutrition risk | Comprehensive nutritional assessment and diagnosis |
| Clinical setting | Recommended as the preferred form for clinical use due to efficiency | Provides additional information for research or in-depth follow-up |
| Validation | Highly validated as a standalone screening tool | Extensive validation, considered the original gold standard |
| Scoring | Based on 6 items, classifies into normal, at-risk, or malnourished | Based on 18 items, provides a detailed nutritional score |
Benefits and Limitations
One of the main benefits of the MNA-SF is its speed and ease of use, making it practical for routine screening in various care settings. It is a reliable and accurate tool for identifying nutritional risk in the elderly. By focusing on key indicators, it can flag potential issues before they become severe, correlating with morbidity and mortality risk. The inclusion of calf circumference as an alternative to BMI is a significant advantage, particularly for bedridden patients where height and weight measurements are challenging. Interestingly, the MNA-SF's items also reflect broader geriatric issues like frailty, making it a valuable tool for comprehensive assessment.
However, some limitations exist. While excellent for screening, the MNA-SF is not a substitute for a full nutritional assessment by a qualified professional when risk is identified. Accuracy can depend on how the tool is administered and by whom. Issues like communicative deficits or severe dementia in patients can impact reliable self-reporting. Proper training is needed to ensure correct measurement of alternatives like calf circumference. For individuals with specific conditions, like those on tube feeding, or for monitoring nutritional intervention, the tool's appropriateness needs consideration.
Using the MNA-SF in Practice
In a clinical or care setting, the MNA-SF provides an efficient first step in managing senior nutrition. For institutionalized older adults, screening is recommended quarterly, while community-dwelling individuals should be screened annually. When a person's MNA-SF score falls into the "at risk" or "malnourished" category, it serves as a trigger for a more in-depth evaluation and the development of a targeted nutritional intervention plan. This may involve diet enhancements or nutritional supplementation, followed by regular monitoring to assess progress. The results can also prompt further investigation into underlying issues such as depression, mobility problems, or other health concerns affecting nutritional intake, offering a holistic view of the person's well-being. For more detailed information on its practical application and scoring, see the guide on the MNA®-elderly website [https://www.mna-elderly.com/sites/default/files/2021-10/mna-guide-english-sf.pdf].
Conclusion
In summary, the MNA short form is a powerful, time-saving tool in the arsenal of geriatric care. Its six questions provide a rapid, yet robust, assessment of nutritional status in older adults, effectively pinpointing those who require more focused attention. By facilitating early intervention for malnutrition risk, the MNA-SF plays a critical role in preserving the health, function, and quality of life for the senior population.
