Validation of the Mini Nutritional Assessment short-form (MNA®-SF): A practical tool for identification of nutritional status

  • M. J. Kaiser
  • J. M. Bauer
  • C. Ramsch
  • W. Uter
  • Y. Guigoz
  • T. Cederholm
  • D. R. Thomas
  • P. Anthony
  • K. E. Charlton
  • M. Maggio
  • A. C. Tsai
  • D. Grathwohl
  • B. Vellas
  • C. C. Sieber
  • MNA-International Group
Validation of the Mini Nutritional Assessment® Short-Form (MNA-SF)



To validate a revision of the Mini Nutritional Assessment short-form (MNA®-SF) against the full MNA, a standard tool for nutritional evaluation.


A literature search identified studies that used the MNA for nutritional screening in geriatric patients. The contacted authors submitted original datasets that were merged into a single database. Various combinations of the questions on the current MNA-SF were tested using this database through combination analysis and ROC based derivation of classification thresholds.


Twenty-seven datasets (n=6257 participants) were initially processed from which twelve were used in the current analysis on a sample of 2032 study participants (mean age 82.3y) with complete information on all MNA items. The original MNA-SF was a combination of six questions from the full MNA. A revised MNA-SF included calf circumference (CC) substituted for BMI performed equally well. A revised three-category scoring classification for this revised MNA-SF, using BMI and/or CC, had good sensitivity compared to the full MNA.


The newly revised MNA-SF is a valid nutritional screening tool applicable to geriatric health care professionals with the option of using CC when BMI cannot be calculated. This revised MNA-SF increases the applicability of this rapid screening tool in clinical practice through the inclusion of a “malnourished” category.

Key words

Mini Nutritional Assessment short-form weight body mass index calf circumference elderly 


  1. 1.
    Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, Morley JE, Chumlea W, Salva A, Rubenstein LZ, Garry P. Overview of the MNA-Its history and challenges. J Nutr Health Aging. 2006 Nov–Dec;10(6):456–463;discussion 463–5.PubMedGoogle Scholar
  2. 2.
    Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature—What does it tell us? J Nutr Health Aging. 2006 Nov–Dec;10(6):466–485; discussion 485–7.PubMedGoogle Scholar
  3. 3.
    Bauer JM, Kaiser MJ, Anthony P, Guigoz Y, Sieber CC. The Mini Nutritional Assessment-its history, today’s practice, and future perspectives. Nutr Clin Pract. 2008 Aug–Sep;23(4):388–396.CrossRefPubMedGoogle Scholar
  4. 4.
    Kondrup J, Allison SP, Elia M, Vellas B, Plauth M; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN).ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003 Aug;22(4):415–421.CrossRefPubMedGoogle Scholar
  5. 5.
    Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: developing the short-form Mini-Nutritional Assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56:M366–372.PubMedGoogle Scholar
  6. 6.
    Elia M. Screening for Malnutrition: A Multidisciplinary Responsibility. Development and Use of the Malnutrition Universal Screening Tool (MUST) for Adults. Malnutrition Advisory Group (MAG), a Standing Committee of BAPEN. Redditch, Worcs.: BAPEN; 2003.Google Scholar
  7. 7.
    Kruizenga HM, Seidell JC, de Vet HC, Wierdsma NJ, van Bokhorst-de van der Schueren MA. Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ). Clin Nutr. 2005 Feb;24(1):75–82.CrossRefPubMedGoogle Scholar
  8. 8.
    Kondrup J, Rasmussen HH, Hamberg O et al. ESPEN working group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22:321–336.CrossRefPubMedGoogle Scholar
  9. 9.
    Anthony PS. Nutrition screening tools for hospitalized patients. Nutr Clin Pract. 2008 Aug–Sep;23(4):373–382.CrossRefPubMedGoogle Scholar
  10. 10.
    Charlton KE, Kolbe-Alexander TL, Nel JH. Development of a novel nutrition screening tool for use in elderly South Africans. Public Health Nutrition. 2005;8(5):468–479.CrossRefPubMedGoogle Scholar
  11. 11.
    Tsai AC, Ku PY. Population-specific Mini Nutritional Assessment effectively predicts the nutritional state and follow-up mortality of institutionalized elderly Taiwanese regardless of cognitive status. Br J Nutr. 2007 Dec; 1–7.Google Scholar
  12. 12.
    Guigoz Y, Vellas B, Garry PJ. Mini Nutritional Assessment: a practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol. 1994:15–59.Google Scholar
  13. 13.
    Kaiser R, Winning K, Uter W, Lesser S, Stehle P, Sieber CC, Bauer JM. Comparison of two different approaches for the application of the Mini Nutritional Assessment in nursing homes: resident interviews versus assessment by nursing staff. JNHA, in press.Google Scholar
  14. 14.
    Norman K, Smoliner C, Valentini L, Lochs H, Pirlich M. Is bioelectrical impedance vector analysis of value in the elderly with malnutrition and impaired functionality? Nutrition. 2007 Jul–Aug;23(7–8):564–569.CrossRefPubMedGoogle Scholar
  15. 15.
    Pauly L. Die Bonner Altenheim-Studie: Integrierte Betrachtung der Ernährungssituation von Alten-heimbewohnern. University of Bonn, Germany. Thesis 2009. URL:
  16. 16.
    Heseker H, Stehle P, Bai J, Lesser S, Overzier S, Paker-Eichelkraut S, Strathmann S. Ernährung älterer Menschen in stationären Einrichtungen (ErnSTES-Studie). In: Deutsche Gesellschaft für Ernährung (Hrsg.): Ernährungsbericht 2008. Druck Center Meckenheim GmbH, Meckenheim (2008) S. 157–204.Google Scholar
  17. 17.
    Elkan AC, Engvall IL, Tengstrand B, Cederholm T, Hafström I. Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools. Eur J Clin Nutr. 2008 Oct;62(10):1239–1247.CrossRefPubMedGoogle Scholar
  18. 18.
    Ödlund Olin A, Koochek A, Ljungqvist O, Cederholm T. Nutritional status, wellbeing and functional ability in frail elderly service flat residents. Eur J Clin Nutr. 2005 Feb;59(2):263–270.CrossRefPubMedGoogle Scholar
  19. 19.
    Ruiz-López MD, Artacho R, Oliva P, Moreno-Torres R, Bolaños J, de Teresa C, López MC. Nutritional risk in institutionalized older women determined by the Mini Nutritional Assessment test: what are the main factors? Nutrition. 2003 Sep;19(9):767–771.CrossRefPubMedGoogle Scholar
  20. 20.
    Magri F, Borza A, del Vecchio S, Chytiris S, Cuzzoni G, Busconi L, Rebesco A, Ferrari E. Nutritional assessment of demented patients: a descriptive study. Aging Clin Exp Res. 2003 Apr;15(2):148–153.PubMedGoogle Scholar
  21. 21.
    Essed NH, van Staveren WA, Kok FJ, de Graaf C. No effect of 16 weeks flavor enhancement on dietary intake and nutritional status of nursing home elderly. Appetite. 2007 Jan;48(1):29–36.CrossRefPubMedGoogle Scholar
  22. 22.
    Visvanathan R, Penhall R, Chapman I. Nutritional screening of older people in a subacute care facility in Australia and its relation to discharge outcomes. Age Ageing 2004;33:260–265.CrossRefPubMedGoogle Scholar
  23. 23.
    Izawa S, Kuzuya M, Okada K, Enoki H, Koike T, Kanda S, Iguchi A. The nutritional status of frail elderly with care needs according to the mini-nutritional assessment. Clin Nutr. 2006 Dec;25(6):962–967.CrossRefPubMedGoogle Scholar
  24. 24.
    Charlton KE, Kolbe-Alexander TL, Nel JH. The MNA, but not the DETERMINE, screening tool is a valid indicator of nutritional status in elderly Africans. Nutrition. 2007 Jul–Aug;23(7–8):533–542.CrossRefPubMedGoogle Scholar
  25. 25.
    Pepersack T. Outcomes of continuous process improvement of nutritional care program among geriatric units. J Gerontol A Biol Sci Med Sci. 2005 Jun;60(6):787–792.PubMedGoogle Scholar
  26. 26.
    Venzin RM, Kamber N, Keller WC, Suter PM, Reinhart WH. How important is malnutrition? A prospective study in internal medicine. Eur J Clin Nutr. 2009 Mar;63(3):430–436.CrossRefPubMedGoogle Scholar
  27. 27.
    Saeglitz C. Mangelernährung bei geriatrischen Patienten im Krankenhaus — Prävalenz, mögliche Ursachen, übliche Therapie und prognostische Bedeutung. University of Bonn, Germany. Thesis 2007. URL:
  28. 28.
    Gómez Ramos MJ, González Valverde FM. High prevalence of undernutrition in Spanish elders admitted to a general hospital and associated factors. Arch Latinoam Nutr. 2005 Mar;55(1):71–76.PubMedGoogle Scholar
  29. 29.
    Schneider SM, Albrecht C, Arab N, Estran S, Vecchio V, Quaranta JF, Négrel M, Guérin O, Hébuterne X, Brocker P. GNRI is the most sensitive marker of malnutrition in a geriatric ward. 28th Congress of the European Society for Clinical Nutrition and Metabolism (ESPEN). Istanbul,19–22 October 2006. e-SPEN 2006;1:154 (P).Google Scholar
  30. 30.
    Gerber V, Krieg MA, Cornuz J, Guigoz Y, Burckhardt P. Nutritional status using the Mini Nutritional Assessment questionnaire and its relationship with bone quality in a population of institutionalized elderly women. J Nutr Health Aging. 2003;7(3):140–145.PubMedGoogle Scholar
  31. 31.
    Rolland Y, Pillard F, Klapouszczak A, Reynish E, Thomas D, Andrieu S, Rivière D, Vellas B. Exercise program for nursing home residents with Alzheimer’s disease: a 1-year randomized, controlled trial. J Am Geriatr Soc. 2007 Feb;55(2):158–165.CrossRefPubMedGoogle Scholar
  32. 32.
    Langkamp-Henken B, Hudgens J, Stechmiller JK, Herrlinger-Garcia KA. Mini nutritional assessment and screening scores are associated with nutritional indicators in elderly people with pressure ulcers. J Am Diet Assoc. 2005 Oct;105(10):1590–1596.CrossRefPubMedGoogle Scholar
  33. 33.
    Dumartheray EW, Krieg MA, Cornuz J, Whittamore DR, Lovell DP, Burckhardt P, Lanham-New SA. Validation and reproducibility of a semi-quantitative Food Frequency Questionnaire for use in elderly Swiss women. J Hum Nutr Diet. 2006 Oct;19(5):321–330.CrossRefPubMedGoogle Scholar
  34. 34.
    Dumartheray EW, Krieg MA, Cornuz J, Whittamore DR, Lanham-New SA, Burckhardt P. Energy and nutrient intake of Swiss women aged 75–87 years. J Hum Nutr Diet. 2006 Dec;19(6):431–435.CrossRefPubMedGoogle Scholar
  35. 35.
    Rolland Y, Pillard F, Garrigue E, Amouyal K, Riviere D, Vellas B. Nutritional intake and recreational physical activity in healthy elderly women living in the community. J Nutr Health Aging. 2005 Nov–Dec;9(6):397–402.PubMedGoogle Scholar
  36. 36.
    Donini LM, Savina C, Rosano A, De Felice MR, Tassi L, De Bernardini L, Pinto A, Giusti AM, Cannella C. MNA predictive value in the follow-up of geriatric patients. J Nutr Health Aging. 2003;7(5):282–293.PubMedGoogle Scholar
  37. 37.
    Thomas DR, Zdrowski CD, Wilson MM, Conright KC, Lewis C, Tariq S, Morley JE. Malnutrition in subacute care. Am J Clin Nutr. 2002 Feb;75(2):308–313.PubMedGoogle Scholar
  38. 38.
    Kuzuya M, Kanda S, Koike T, Suzuki Y, Satake S, Iguchi A. Evaluation of Mini-Nutritional Assessment for Japanese frail elderly. Nutrition. 2005 Apr;21(4):498–503.CrossRefPubMedGoogle Scholar
  39. 39.
    Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med. 2002 Nov;18(4):737–757.CrossRefPubMedGoogle Scholar
  40. 40.
    Nutritional support strategy for protein-energy malnutrition in the elderly. Guidelines. Haute Autorité de Santé (HAS), France. April 2007.Google Scholar
  41. 41.
    Vellas B, Lauque S, Andrieu S, Nourhashemi F, Rolland Y, Baumgartner R, Garry P. Nutrition assessment in the elderly. Curr Opin Clin Nutr Metab Care. 2001 Jan;4(1):5–8.CrossRefPubMedGoogle Scholar
  42. 42.
    Rolland Y, Lauwers-Cances V, Cournot M, Nourhashémi F, Reynish W, Rivière D, Vellas B, Grandjean H. Sarcopenia, calf circumference, and physical function of elderly women: a cross-sectional study. J Am Geriatr Soc. 2003 Aug;51(8):1120–1124.CrossRefPubMedGoogle Scholar
  43. 43.
    Jauffret M Jusot JF Bonnefoy M. Anthropometric markers and malnutrition in elderly people: calf circumference interest. Age & Nutrition. 1999;10(3):163–169.Google Scholar
  44. 44.
    Bonnefoy M, Jauffret M, Kostka T, Jusot JF. Usefulness of calf circumference measurement in assessing the nutritional state of hospitalized elderly people. Gerontology. 2002 May–Jun;48(3):162–169.CrossRefPubMedGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2009

Authors and Affiliations

  • M. J. Kaiser
    • 1
  • J. M. Bauer
    • 1
  • C. Ramsch
    • 2
  • W. Uter
    • 2
  • Y. Guigoz
    • 3
  • T. Cederholm
    • 4
  • D. R. Thomas
    • 5
  • P. Anthony
    • 3
  • K. E. Charlton
    • 6
  • M. Maggio
    • 7
  • A. C. Tsai
    • 8
  • D. Grathwohl
    • 9
  • B. Vellas
    • 10
  • C. C. Sieber
    • 1
  • MNA-International Group
  1. 1.Institute for the Biomedicine of AgingFriedrich-Alexander University Erlangen-NürnbergNurembergGermany
  2. 2.Department of Medical Informatics, Biometry and EpidemiologyFriedrich-Alexander University Erlangen-NürnbergErlangenGermany
  3. 3.Nestlé Nutrition/HealthCare NutritionGlandSwitzerland
  4. 4.Clinical Nutrition and Metabolism, Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
  5. 5.Division of Geriatric MedicineSaint Louis University Health Sciences CenterSaint LouisUSA
  6. 6.School of Health Sciences, Faculty of Health and Behavioural SciencesUniversity of WollongongWollongongAustralia
  7. 7.Department of Internal Medicine and Biomedical Sciences, Section of GeriatricsUniversity Hospital of ParmaParmaItaly
  8. 8.Graduate Institute of Long-Term Care, Department of Healthcare AdministrationAsia UniversityWufeng, TaichungTaiwan, ROC
  9. 9.Nestlé Research Center, Vers-chez-les-BlancsLausanne 26Switzerland
  10. 10.Department of Geriatrics, INSERM U 558Toulouse University Hospital CenterToulouseFrance

Personalised recommendations