The MNA® remains the gold-standard today for nutritional screening in the elderly. Only the MNA® was especially developed and validated for use in the elderly and incorporates special considerations for the elderly (e.g. functionality, depression, and dementia).17 Its design makes it more likely than other screening tools to identify risk of malnutrition and undernutrition at an early stage. ESPEN recommends the MNA® as the preferred tool for screening the elderly.
The MNA® is more specific than the Nutrition Screening Initiative DETERMINE Checklist, which has not been validated and actually functions as a better education tool than diagnostic tool.42
The MNA® was also shown to be better for early screening than the Subjective Global Assessment (SGA), which was developed for patients with malignant gastrointestinal diseases and requires special training to administer.
Whereas the Malnutrition Universal Screening Tool (MUST) was developed specifically for people living in the community and lacks any measure of functionality, the MNA® has been validated in the elderly in many care settings (free living, long term care, and acute care) and assesses functionality, an important consideration in the elderly.
The Nutritional Risk Screening (NRS) was developed for hospitalized patients and not specifically for the elderly.16
The MNA remains the most widely used and accepted tool to screen the elderly for nutrition risk.
Though the MNA® was originally designed and validated in Europe and the United States, it has been translated into numerous languages and used in countries around the world that have similar Western health care practice settings. However, it may not be directly applicable in many ethnic groups or countries or those with non-Western cultural and dietary habits or health care systems. Adapting the MNA® to those other population groups depends on making it as country or culturally and ethnically specific as possible. The Chinese Nutrition Assessment is an example.43
The MNA® can be used in a variety of settings to detect those elderly patients (65 and older) who could benefit from early nutrition intervention. This includes on admission to hospitals or nursing homes, in geriatric clinics, geriatric feeding programs, health screenings and health fairs, geriatric day programs, assisted living sites, home care settings, dental clinics44, dialysis centers, community-based nursing programs, and physician offices.
The MNA® may be used to re-screen for nutrition risk every three months.
Many studies have shown the value of the MNA® in identifying nutritional risk of elderly residents in long term care, or nursing homes.
The MNA® -SF can be used as the initial evaluation on admission to the nursing home to detect nutrition risk. If the result of the MNA® -SF is <12 points, the full MNA is completed to help identify potential causes of poor nutritional state. For example, if a patient needs help when eating, the MNA® can help determine whether the problem is due to dysphagia or to poor dental status. The results of the full MNA® then direct any needed nutritional therapy (see score algorithm).
The MNA® can be used periodically throughout an extended nursing home stay to re-screen those patients who were not at risk on admission. It can also help evaluate response to nutrition intervention in patients who were malnourished or at risk. The MNA® may need to be repeated every 3 months (see MNA® guide).
The MNA® has not been validated as a screening tool for the entire age span found in most acute care hospitals. It may, however, augment a more general hospital screen when applied to elderly patients who are found to be at nutrition risk on the more general screen.45
Yes, the MNA® can be used to identify elderly patients with cancer who are malnourished or at risk of malnutrition, and it can facilitate timely initiation of nutrition support. Since the MNA® was validated specifically for the elderly, it is not intended to be used across the entire age span of all patients with cancer.
The MNA® may be used in elderly patients who are fed mashed or pureed foods. Elderly patients with chewing or swallowing disorders (i.e. those requiring mashed or pureed foods) are at risk of malnutrition, and evaluating their nutritional status with the MNA® and initiating nutritional therapy is very important. Patients who are identified as “at risk” on the MNA® merit close monitoring to ensure they receive appropriate nutrition intervention. The MNA® should be repeated every three months.
The MNA® -SF is an excellent tool for mandatory nutrition screening of elderly participants in government-funded nutrition programs (congregate meals sites, meals on wheels, etc.). Early detection of those at risk of malnutrition can lead to early intervention which is more cost effective. In addition, using a validated screen to identify high-risk patients for malnutrition may help document the need for adequate program funding.
The MNA® is a very useful tool for assisted living facilities where routine nutrition screening and assessment is not currently in place, yet maintenance of functional status is important to prevent transfer to a more expensive nursing home setting46.
Yes, the MNA® can be used in elderly obese patients whom studies have shown may have poor quality diets, micronutrient deficiencies, and malnutrition, especially female overweight older patients.47 At the time the MNA® was validated, the subjects included some obese subjects.
With the dramatic rise in obesity over the last 15 years, the issue of weight loss, which is generally desirable in the obese, raises questions about the value of BMI in detecting malnutrition in this population. Weight, however, is only one measure of undernutrition on the MNA® ; other factors (e.g. decreased intake, presence of acute disease or depression, and lack of mobility) are used along with the BMI to determine risk of malnutrition. These factors may be present in the overweight, especially the overweight resident in a nursing home, and increase the risk for malnutrition.
MNA® may, therefore, be an effective screening tool in the overweight nursing home resident and should be repeated on a regular basis (every 3 or 6 months). Omitting the weight loss question reduces the sensitivity of the MNA® , so it is important to ask about weight loss.
The MNA® -SF requires no special training and can be completed in three to five minutes. It does not have to be completed by a health care professional and is commonly completed by support staff.
The full MNA® is easily administered by health professionals (physicians, dietitians, nurses, research assistants, etc.) in a variety of settings and takes 10-15 minutes to complete. With thorough training in taking simple anthropometric measurements (mid-arm and calf circumference measurements), support staff can also learn to administer the full MNA® .
No, the MNA® is a screening tool and was not designed to monitor nutritional intervention. However, the MNA® can be used to do follow-up screening. For example, studies have shown that MNA® scores improve on re-screening in subjects who received timely intervention after being initially identified as at risk for malnutrition or undernourished.49
Changing or deleting any of the questions or the answers on a validated questionnaire makes it different from the original. These changes to the questionnaire also change the validity. The reported validity of the MNA® are no longer correct after any changes to any questions or answers, and a new validity must be determined before being used clinically.