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Printed on 7/20/2026
For informational purposes only. This is not medical advice.
The Mini Nutritional Assessment - Short Form (MNA-SF) is a validated geriatric nutrition screening tool that evaluates intake, weight loss, mobility, stress/acute disease, neuropsychological issues, and BMI (or calf circumference surrogate).
Formula: MNA-SF total is the sum of 6 item scores, range 0-14.
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The MNA-SF has six items assessing the primary nutritional risk domains in older adults. Ask the patient (or their caregiver if the patient has dementia) and supplement with clinical observation: (1) Food intake decline in the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties: 0=Severe decrease; 1=Moderate decrease; 2=No decrease in food intake. (2) Weight loss during the last 3 months: 0=Weight loss greater than 3 kg; 1=Weight loss unknown; 2=Weight loss between 1 and 3 kg; 3=No weight loss. (3) Mobility: 0=Bed or chair-bound; 1=Able to get out of bed/chair but does not go out; 2=Goes out. (4) Has suffered psychological stress or acute disease in the past 3 months: 0=Yes; 2=No. (5) Neuropsychological problems: 0=Severe dementia or depression; 1=Mild dementia; 2=No psychological problems. (6a) Body Mass Index (BMI in kg/m²): 0=BMI less than 19; 1=BMI 19 to less than 21; 2=BMI 21 to less than 23; 3=BMI 23 or greater. If BMI cannot be measured (non-ambulant or splint/oedema preventing measurement), substitute calf circumference (6b): 0=Calf circumference less than 31 cm; 3=Calf circumference 31 cm or greater. Do NOT use both 6a and 6b simultaneously.
Add the scores from all six MNA-SF items (using either 6a or 6b for item 6). The maximum total score is 14 points. Item score ranges: item 1 = 0–2; item 2 = 0–3; item 3 = 0–2; item 4 = 0 or 2; item 5 = 0–2; item 6a or 6b = 0–3. Maximum possible = 2+3+2+2+2+3 = 14. A patient with no weight loss, no food intake decrease, fully mobile, no recent illness or stress, no psychological problems, and BMI ≥23 scores 14/14 — normal nutritional status. A patient with severe food intake decrease, >3 kg weight loss, bed-bound, recent acute illness, severe dementia, and BMI <19 scores 0/14 — frank malnutrition requiring urgent intervention.
MNA-SF interpretation: 12–14 = Normal nutritional status — no intervention required at this time. Reassess at clinic follow-up or if clinical status changes. 8–11 = At risk of malnutrition — initiate nutrition intervention: formal dietary assessment and dietitian referral; protein and calorie intake optimization; high-calorie/high-protein oral nutritional supplements (ONS) if intake is insufficient; address underlying causes (appetite loss, swallowing difficulty, depression, social isolation, medication side effects); and rescreen at 4–6 weeks. 0–7 = Malnourished — urgent nutrition intervention required: dietitian consultation (priority), formal caloric and protein needs assessment; consider ONS, enteral nutrition (nasogastric or PEG feeding) if oral intake insufficient; vitamin and micronutrient supplementation; treat underlying causes; multidisciplinary team review; weigh weekly to track response. For any patient scoring 0–11, supplement MNA-SF with a full nutrition assessment: 24-hour dietary recall, food diary, blood investigations (albumin, pre-albumin, total protein, vitamin D, B12, iron), swallowing assessment (if applicable), and medication review for anorexigenic side effects.
Geriatricians, primary care physicians, practice nurses, dietitians
Malnutrition affects 15–30% of community-dwelling elderly over 75, rising to 30–60% in care homes and >50% in acute hospital elderly patients. MNA-SF is the only nutrition screening tool developed and validated specifically for older adults, making it the preferred instrument for geriatric primary care and specialist clinic use. ESPEN (European Society for Clinical Nutrition and Metabolism) and BAPEN (British Association for Parenteral and Enteral Nutrition) endorse MNA-SF for nutrition screening in older adults aged 65+. Annual MNA-SF screening during wellness visits for all patients ≥75 identifies early malnutrition risk before overt weight loss develops. MNA-SF ≤11 triggers dietitian referral and nutritional intervention.
Hospital dietitians, nutritional support nurses, ward nurses, admission staff
Up to 45% of older adults enter hospital with pre-existing malnutrition, and nutritional status deteriorates further during hospitalization due to meal interruptions, procedures, reduced appetite with illness, and post-operative recovery. MNA-SF completed within 24 hours of hospital admission identifies malnourished and at-risk patients who need early dietitian review and nutritional intervention. Hospital-acquired malnutrition (or worsening of pre-existing malnutrition) is associated with longer length of stay, higher infection rates, impaired wound healing, and increased 30-day readmission. Joint Commission and NICE (NG22: Nutrition support for adults) require nutrition screening on hospital admission — MNA-SF satisfies this requirement for older adult populations.
Nursing home physicians, care home staff, community dietitians, MDS coordinators
Malnutrition prevalence in UK care homes is estimated at 30–40% of residents, making it one of the highest-impact quality improvement targets in long-term care. MDS (Minimum Data Set) in US nursing homes requires nutrition risk assessment; MNA-SF is a validated alternative to MUST for older nursing home populations. Quarterly MNA-SF reassessment tracks nutritional trajectory and documents response to nutritional interventions. Weight loss of >5% over 3 months (captured in MNA-SF item 2) is a key quality indicator for regulatory review. Care home staff training on MNA-SF administration enables consistent nutritional surveillance across large residential populations.
Surgical pre-assessment nurses, anaesthetists, surgical teams, perioperative dietitians
Pre-operative malnutrition (MNA-SF ≤11) significantly increases post-operative complication rates, wound healing delay, infection risk, length of stay, and nursing home discharge rates in older adults undergoing major surgery. ERAS (Enhanced Recovery After Surgery) protocols for patients aged 65+ recommend pre-operative nutritional screening and optimization. Pre-operative MNA-SF ≤11 triggers: 7–14 days of pre-operative nutritional optimization before elective surgery (high-protein oral supplements 2x/day, dietitian-guided dietary counseling); prehabilitation nutrition component; carbohydrate loading protocols before surgery. MNA-SF is preferred over MUST for pre-operative screening in older adults due to its age-specific validation.
Dementia care nurses, geriatric psychiatrists, memory clinic staff, care home nutrition leads
Patients with dementia are at high malnutrition risk due to: forgetting to eat or difficulty recognizing food; dysphagia as dementia progresses; apraxia affecting self-feeding ability; behavioral symptoms (agitation, pacing) increasing caloric expenditure; depression affecting appetite; and medication side effects. MNA-SF item 5 (neuropsychological problems) captures dementia severity directly, and items 1–3 reflect the functional nutritional consequences of cognitive decline. In dementia patients, MNA-SF should be completed by the caregiver (rather than the patient) with direct observation of meal consumption to supplement self-report. Quarterly MNA-SF monitoring in memory clinic follow-up tracks nutritional trajectory as dementia severity progresses.
For non-ambulant patients (bed-bound, wheelchair users, lower limb oedema making weight measurement unreliable, inability to stand for height measurement), use calf circumference as the validated BMI substitute in MNA-SF item 6b: measure the widest circumference of the lower leg with the patient seated and knee at 90°, using a flexible tape measure; <31 cm = 0 points; ≥31 cm = 3 points. Calf circumference <31 cm in older adults correlates with low skeletal muscle mass and has been validated as a proxy for low BMI in the MNA-SF context. Do NOT estimate BMI from memory or use an estimated weight — if BMI is truly unobtainable, use calf circumference.
Item 4 scores acute disease or psychological stress in the past 3 months: 0=Yes (stress occurred); 2=No (no stress). The zero-point score for 'Yes' is counterintuitive to clinicians who expect higher scores to be worse — and MNA-SF uses opposite scoring direction to this instinct (higher score = better). Any hospitalization in the past 3 months, recent acute illness (pneumonia, UTI, CHF exacerbation, surgery), or significant psychological stress should be scored 0. The item specifically asks 'Was the patient stressed or ill in the past 3 months?' — a simple Yes/No question. Verify this item at each assessment.
MNA-SF thresholds (12–14=normal, 8–11=at risk, 0–7=malnourished) apply specifically to older adults aged 65+. MUST (Malnutrition Universal Screening Tool) uses different thresholds and was designed for adult populations including younger adults. In geriatric settings, MNA-SF is preferred over MUST because it includes age-specific items (mobility, cognitive/psychological status) that MUST does not capture. When using MNA-SF, apply its own validated thresholds — do not cross-reference to MUST score interpretations.
MNA-SF is a validated screening tool but should be supplemented with objective nutritional markers for full assessment: body weight and serial weight tracking (weigh weekly at minimum for at-risk patients); serum albumin (reduced in chronic malnutrition and inflammation — <3.5 g/dL is a red flag); pre-albumin/transthyretin (shorter half-life than albumin, more sensitive to acute nutritional changes); vitamin D, B12, folate, iron panel (micronutrient deficiencies common in elderly malnutrition); and handgrip strength (surrogate for protein-calorie adequacy). Clinically significant malnutrition should not be dismissed solely because the patient 'appears to be eating adequately' — micronutrient deficiencies can occur in macronutrient-sufficient patients.
MNA-SF item 2 (weight loss in past 3 months) is only scoreable if weight data is available. Many elderly patients lack recent weight records, which defaults them to 'Unknown' (score 1) — missing a key malnutrition indicator. Regular weighing — ideally at every clinic visit or at monthly intervals in care homes — provides the weight trend data needed to score item 2 accurately. In hospitals, daily or every-other-day weighing for nutritionally at-risk patients enables early detection of ongoing weight loss and timely nutritional intervention. Unintentional weight loss >5% over 3 months or >10% over 6 months is a major malnutrition criterion regardless of current BMI.
Nutritional supplements alone are insufficient if underlying causes of malnutrition are not addressed. Identify and treat: dysphagia (speech and language therapy assessment for patients with stroke, Parkinson's, head and neck cancer); depression and grief (PHQ-9 screening, antidepressant therapy trial if indicated); poor dentition (dental referral for ill-fitting dentures, tooth pain); medication side effects (anorexigenic drugs: digoxin, metformin, SSRIs at high doses, opioids, CNS medications); social isolation and poverty (social worker referral for Meals on Wheels, grocery delivery, food banks); and swallowing anxiety (post-aspiration fear — SLT assessment and reassurance). Nutritional supplementation is more effective when underlying barriers to intake are resolved.
If MNA-SF scores 8–11 (at risk) but the clinical picture is ambiguous — for example, the patient reports normal appetite but has lost weight — the full 18-item MNA can be performed for more detailed assessment. The full MNA includes additional items on dietary assessment (number of meals, protein intake, fruit/vegetable consumption), self-assessment of nutritional status and health, and mid-arm circumference. The full MNA scores 0–30 with thresholds: 24–30=normal; 17–23.5=at risk; <17=malnutrition. MNA-SF ≤11 and full MNA <24 would both indicate intervention is warranted. MNA-SF is sufficient for routine screening; the full MNA is useful for detailed nutritional characterization when dietary history depth is needed.
MNA-SF developed from the full 18-item MNA by Rubenstein LZ et al. (J Gerontol 2001); validated in 155 elderly outpatients against full MNA and clinical assessment. Original full MNA: Guigoz Y, Vellas B, Garry PJ (Nutr Rev 1996). ESPEN geriatric nutrition guideline (Volkert et al., Clin Nutr 2019) recommends MNA as preferred screening tool for older adults. Comprehensive meta-analysis confirming validity: Kaiser MJ et al. (J Nutr Health Aging 2010) — MNA-SF sensitivity 96%, specificity 98% vs. full MNA in community-dwelling elderly. BAPEN MUST vs. MNA comparative studies: Stratton RJ et al. (Clin Nutr 2004).
Lower MNA-SF totals indicate higher malnutrition risk and stronger need for formal nutrition follow-up.
Use in older adults during clinic visits, admission screening, rehabilitation intake, and periodic longitudinal reassessment.
Scores can be influenced by acute illness and interview reliability; MNA-SF should be combined with clinical judgment and objective nutrition data.
For related assessments, see MUST Score, Protein Intake and Calorie Calculator.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
April 21, 2026 · trust-baseline
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