Nutrition Screening - Illinois
Nutrition ScreeningasasA guide to completing theMini Nutritional Assessment – Short Form(MNA -SF)Screen and intervene.Nutrition can make a difference.Print CMYK Blue C 100% / M 72% / B 18% Green C 80% / Y 90%
IntroductionMini Nutritional Assessment – Short Form (MNA -SF)The MNA -SF is a screening tool to help identify elderly patients who are malnourished or at risk ofmalnutrition. This User Guide will assist you in completing the MNA -SF accurately and consistently.It explains each question and how to assign and interpret the score.IntroductionWhile the prevalence of malnutrition in the free living elderly population is relatively low, the risk ofmalnutrition increases dramatically in the institutionalized and hospitalized elderly.1 The prevalenceof malnutrition is even higher in cognitively impaired elderly individuals and is associated withcognitive decline.2Patients who are malnourished when admitted to the hospital tend to have longer hospital stays,experience more complications, and have greater risks of morbidity and mortality than those whosenutritional state is normal.3By identifying older persons who are malnourished or at risk of malnutrition either in the hospital orcommunity setting, the MNA -SF allows clinicians to intervene earlier to provide adequate nutritionalsupport, prevent further deterioration, and improve patient outcomes.4Mini Nutritional Assessment – Short Form (MNA -SF)The MNA -SF provides a simple and quick method of identifying elderly persons who are at risk formalnutrition, or who are already malnourished. It identifies the risk of malnutrition before severechanges in weight or serum protein levels occur.The MNA -SF was developed by Nestlé and leading international geriatricians and remains one ofthe few validated screening tools for the elderly. It has been well validated in international studies ina variety of settings5-7 and correlates with morbidity and mortality.In 2009 the MNA -SF was validated as a stand alone screening tool, based on the full MNA .8 TheMNA -SF may be completed at regular intervals in the community and in the hospital or long-termcare setting. It is recommended to be done annually in the community, and every 3 months in thehospital or long-term care or whenever a change in clinical condition occurs.Instructions to complete the MNA -SFBefore beginning the MNA -SF, please enter the patient’s information on the top of the form: Name Gender Age eight (kg) – To obtain an accurate weight, remove shoes and heavy outer clothing. Use aWcalibrated and reliable set of scales. Pounds (lbs) must be converted to kilograms (1 lb 0.45 kg). Height (cm) – Measure height without shoes using a stadiometer (height gauge). If the patient isbedridden, measure height by demispan, half arm-span, or knee height (see Appendix 2). Inchesmust be converted to centimeters (1 inch 2.54 cm). 2Date of screen
IdentifyThe Mini Nutritional Assessment Short Form (MNA -SF) is an effective tool to help identify patientswho are malnourished or at risk of malnutrition4Most validated tool for the elderly- Sensitive and reliable- Recommended by national and international organisations- Supported by more than 450 published studies4Quick and easy to use- S creen in less than5 minutes- Requires no special training- No laboratory data needed4Effective- I dentifies at-risk personsbefore weight loss occurs4Facilitates early interventionInterveneRecommend Nestlé Nutritionsupplements to help your patientsimprove their nutritional statusMonitor4Inexpensive diagnostic tool- T he MNA -SF toolallows standardised,reproducible andreliable determination ofnutritional status- U se the MNA -SFregularly to assess yourpatients’ nutritionalstatus and provideintervention as requiredScreen and intervene. Nutrition can make a difference.3
Screening (MNA -SF)Complete the screen by filling in the boxes with the appropriate numbers. Total the numbers for thefinal screening score.Key PointsAsk the patient to answer questions A – F, using the suggestions in the shaded areas. If the patient isunable to answer the question, ask the patient’s caregiver to answer or check the medical record.AHas food intake declined over the past threemonths due to loss of appetite, digestiveproblems, chewing or swallowing difficulties?Score 0 Severe decrease in food intake1 Moderate decrease in food intake2 No decrease in food intakeAsk patient or caregiver or check themedical record “Have you eaten less than normal over thepast three months?” If so, “is this because of lack of appetite,chewing, or swallowing difficulties?” If yes, “have you eaten much less thanbefore or only a little less?”BInvoluntary weight loss during the last3 months?Score 0 Weight loss greater than 3 kg(6.6 pounds)1 Does not know2 Weight loss between 1 and 3 kg(2.2 and 6.6 pounds)3 No weight loss4Ask patient / Review medical record “Have you lost any weight without tryingover the last 3 months?” “Has your waistband gotten looser?” “How much weight do you think you havelost? More or less than 3 kg (or 6 pounds)?”Though weight loss in the overweightelderly may be appropriate, it may also bedue to malnutrition. When the weight lossquestion is removed, the MNA loses itssensitivity, so it is important to ask aboutweight loss even in the overweight.
CMobility?Score 0 Bed or chair bound1 Able to get out of bed/chair, butdoes not go out2 Goes outAsk patient / Review patient’s medicalrecord / Ask caregiver “How would you describe your currentmobility?”– “Are you able to get out of a bed, a chair,or a wheelchair without the assistance ofanother person?” – if not, would score 0– “Are you able to get out of a bed or a chair,but unable to go out of your home?” – ifyes, would score 1– “ Are you able to leave your home?” – if yes,would score 2DHas the patient suffered psychological stressor acute disease in the past three months?Ask patient / Review patient medical record /Use professional judgmentScore 0 Yes “Have you been stressed recently?”2 No “Have you been severely ill recently?”ENeuropsychological problems?Score 0 Severe dementia or depression1 Mild dementia2 No psychological problemsReview patient medical record / Useprofessional judgment / Ask patient,nursing staff or caregiver “Do you have dementia?” “Have you had prolonged or severesadness?”The patient’s caregiver, nursing staff ormedical record can provide informationabout the severity of the patient’sneuropsychological problems (dementia).Screen and intervene. Nutrition can make a difference.5
F1Body mass index (BMI)?(weight in kg / height in m2)Score 0 BMI less than 191 BMI 19 to less than 212 BMI 21 to less than 233 BMI 23 or greaterDetermining BMIBMI is used as an indicator of appropriateweight for height (Appendix 1)BMI Formula – US units BMI ( Weight in Pounds /[Height in inches x Height in inches] ) x 703BMI Formula – Metric units BMI ( Weight in Kilograms /[Height in Meters x Height in Meters] )1 Pound 0.45 Kilograms1 Inch 2.54 CentimetersBefore determining BMI, record the patient'sweight and height on the MNA form.1. If height has not been measured, pleasemeasure using a stadiometer or heightgauge (Refer to Appendix 2).2. If the patient is unable to stand, measureheight using indirect methods such asmeasuring demi-span, arm span, or kneeheight. (See Appendix 2).3. Using the BMI chart provided (Appendix 1),locate the patient’s height and weight anddetermine the BMI.4. Fill in the appropriate box on the MNA form to represent the BMI of the patient.5. To determine BMI for a patient with anamputation, see Appendix 3.IF BMI IS NOT AVAILABLE, REPLACE QUESTION F1 WITH QUESTION F2.DO NOT ANSWER QUESTION F2 IF QUESTION F1 IS ALREADY COMPLETED.6
F2 Answer only if unable to obtain BMI.Calf circumference (CC) in cmMeasuring Calf Circumference0 CC less than 311. The subject should be sitting with the leftleg hanging loosely or standing with theirweight evenly distributed on both feet.3 CC 31 or greater2. Ask the patient to roll up their trouser legto uncover the calf.3. Wrap the tape around the calf at the widestpart and note the measurement.4. Take additional measurements above andbelow the point to ensure that the firstmeasurement was the largest.5. An accurate measurement can only beobtained if the tape is at a right angle tothe length of the calf.To measure calf circumference in bedbound elderly, please refer to Appendix 4Add the numbers to obtain the screening score.Screening Score(Max. 14 points)12-14 points: Normal nutritional status8-11 points: At risk of malnutrition0-7 points: MalnourishedFor proposed intervention, please see the algorithm on the next page.For more information, go to www.mna-elderly.comScreen and intervene. Nutrition can make a difference.7
Recommendations for InterventionMNA ScoreNormalNutritional Status(12 – 14 points)RESCREENAt Riskof Malnutrition(8 – 11 points)Malnourished(0-7 points)No Weight LossWeight LossMONITORTREAT A fter acuteevent or illness C lose weightmonitoring O nce per yearin communitydwelling elderly R escreenevery 3 months E very 3 months ininstitutionalizedpatients Nutritionintervention- Diet enhancement- Oral nutritionalsupplementation(400 kcal/d)1 Close weightmonitoring Further in-depthnutritionassessmentTREAT N utritionintervention-O ral nutritionalsupplementation(400-600 kcal/d)2-D iet enhancement C lose weightmonitoring F urther in-depthnutritionassessment1. Milne AC, et al. Cochrane Database Syst Rev. 2009:2:CD0032882. Gariballa S, et al. Am J Med. 2006;119:693-699Note: In the elderly, weights and heights areimportant because they correlate with morbidityand mortality.Weight and height measurements are oftenavailable in the patient record and shouldbe used as a priority. Only when heightand/or weight are unavailable, should CalfCircumference (CC) be used instead of BMI.Important: When the Calf Circumference isused to complete the MNA -SF, do not use thefull MNA . Otherwise, the full MNA score will8be inaccurate due to the Calf Circumferencemeasurement being counted twice – once in theMNA -SF and again in Question R of thefull MNA .Follow-UpRescreen all institutionalized elderly patientsevery three months and normally nourishedelderly patients annually in the community.Please refer results of assessments and reassessments to dietitian/doctor and record inmedical record.
AppendicesAppendixAppendix11 Body Mass Index tableMNA BMI Table for the Elderly (age 65 and above)Height (feet & 323334353637383940414243444547484849515’0” 5’1” 5’2” 5’3” 5’4” 5’5” 5’6” 5’7” 5’8” 5’9” 5’10” 5’11” 6’0” 6’1” 6’2” 0185190195200205210215220225230234240245250Weight (pounds)Weight (kg)4’11”150 152.5 155 157.5 160 162.5 165 167.5 170 172.5 175 177.5 180 182.5 185 188 190Height (cm)nn0 BMI less than 191 BMI 19 to less than 21nn2 BMI 21 to less than 233 BMI 23 or greaterThis abbreviated BMI table is provided for your convenience and facilitates completingthe MNA . It is accurate for the MNA . In some cases, calculating the BMI may yield amore precise BMI determination.Screen and intervene. Nutrition can make a difference.9
Appendix 2 Ways of Measuring Height2.1 Measuring height using a stadiometer1. Ensure the floor surface is even and firm.2. Have subject remove shoes and stand upstraight with heels together, and with heels,buttocks and shoulders pressed againstthe stadiometer.3. Arms should hang freely with palmsfacing thighs.4. Take the measurement with the subjectstanding tall, looking straight ahead with thehead upright and not tilted backwards.5. Make sure the subject's heels stay flat onthe floor.6. Lower the measure on the stadiometer untilit makes contact with the top of the head.7. Record standing height to the nearestcentimeter.Accessed rt iii5.htmAccessed January 15, 2011.2.2 Measuring height using demispanDemispan (half-arm span) is the distance fromthe midline at the sternal notch to the webbetween the middle and ring fingers alongoutstretched arm. Height is then calculated froma standard formula.91. Locate and mark the midpoint of the sternalnotch with the pen.2. Ask the patient to place the left arm in ahorizontal position.Calculate height from the formula below:FemalesHeight in cm (1.35 x demispan in cm) 60.1MalesHeight in cm (1.40 x demispan in cm) 57.8Demi-span3. Check that the patient’s arm is horizontal andin line with shoulders.4. Using the tape measure, measure distancefrom mark on the midline at the sternal notchto the web between the middle and ringfingers.5. Check that arm is flat and wrist is straight.6. Take reading in cm.Source:Reproduced here with the kind permission of BAPEN( British Association for Parenteral and Enteral Nutrition )from the ‘MUST’ Explanatory Booklet.For further information see /must explan.pdf)10
2.3 Measuring height using half arm-spanHalf arm-span is the distance from the midlineat the sternal notch to the tip of the middlefinger. Height is then calculated by doubling thehalf arm-span.10Calculate height by multiplying the halfarm-span measurement by 2Half arm-span1. Locate and mark the edge of the right collarbone (in the sternal notch) with the pen.2. Ask the patient to place the nondominant armin a horizontal position.3. Check that the patient’s arm is horizontal andin line with shoulders.4. Using the tape measure, measure distancefrom mark on the midline at the sternal notchto the tip of the middle finger.Source:http://www.rxkinetics.com/height estimate.html.Accessed January 15, 2011.5. Check that arm is flat and wrist is straight.6. Take reading in cm.Screen and intervene. Nutrition can make a difference.11
2.4 Measuring height using knee heightKnee height is one method used to determinestatue in the bed- or chair-bound patient and ismeasured using a sliding knee height caliper.The patient must be able to bend both the kneeand the ankle of one leg to 90 degree angles.Source:http://www.rxkinetics.com/height estimate.html.Accessed January 15, 2011.1. Have the subject bend the knee and ankleof one leg at a 90 degree angle while lyingsupine or sitting on a table with legs hangingoff the table.2. Place the fixed blade of the knee caliperunder the heel of the foot in line with theankle bone. Place the fixed blade of thecaliper on the anterior surface of the thighabout 3.0 cm above the patella.3. Be sure the shaft of the caliper is in line withand parallel to the long bone in the lowerleg (tibia) and is over the ankle bone (lateralmalleolus). Apply pressure to compressthe tissue. Record the measurement to thenearest 0.1 cm.4. Take two measurements in immediatesuccession. They should agree within 0.5 cm.Use the average of these two measurementsand the patient’s chronological age in thepopulation and gender-specific equationsin the table on the right to calculate thesubject’s stature.5. The value calculated from the selectedequation is an estimate of the person’s truestature. The 95 percent confidence for thisestimate is plus or minus twice the SEEvalue for each equation.12Using population-specific formula, calculateheight from standard formula:Population andGender groupEquation:Stature (cm) Non-Hispanic white men(U.S.)11 [SEE 3.74 cm]78.31 (1.94 x knee height)– (0.14 x age)Non-Hispanic black men(U.S.)11 [SEE 3.80 cm]79.69 (1.85 x knee height)– (0.14 x age)Mexican-American men(U.S.)11 [SEE 3.68 cm]82.77 (1.83 x knee height)– (0.16 x age)Non-Hispanic white women(U.S.)11 [SEE 3.98 cm]82.21 (1.85 x knee height)– (0.21 x age)Non-Hispanic black women(U.S.)11 [SEE 3.82 cm]89.58 (1.61 x knee height)– (0.17 x age)Mexican-American women(U.S.)11 [SEE 3.77 cm]84.25 (1.82 x knee height)– (0.26 x age)Taiwanese men12[SEE 3.86 cm]85.10 (1.73 x knee height)– (0.11 x age)Taiwanese women12[SEE 3.79 cm]91.45 (1.53 x knee height)– (0.16 x age)Elderly Italian men13[SEE 4.3 cm]94.87 (1.58 x knee height)– (0.23 x age) 4.8Elderly Italian women13[SEE 4.3 cm]94.87 (1.58 x knee height)– (0.23 x age)French men14[SEE 3.8 cm]74.7 (2.07 x knee height)– (-0.21 x age)French women14[SEE 3.5 cm]67.00 (2.2 x knee height)– (0.25 x age)Mexican Men15[SEE 3.31 cm]52.6 (2.17 x knee height)Mexican Women15[SEE 2.99 cm]73.70 (1.99 x knee height)– (0.23 x age)Filipino Men1696.50 (1.38 x knee height)– (0.08 x age)Filipino Women1689.63 (1.53 x knee height)– (0.17 x age)Malaysian men17[SEE 3.51 cm](1.924 x knee height) 69.38Malaysian women17[SEE 3.40](2.225 x knee height) 50.25SEE Standard Error of Estimate11
Appendix 3 Determining BMI for amputeesTo determine the BMI for amputees, firstdetermine the patient’s estimated weightincluding the weight of the missing body part.18,19 U se a standard reference (see table) todetermine the proportion of body weightcontributed by an individual body part. S ubtract the percentage of body weightcontributed by the missing body part(s)from 1.0. T hen, divide the current weight by thedifference of 1 minus the percentage of bodyweight contributed by the missing body part.Calculate BMI using estimated height andestimated weight.Weight of selected body componentsIt is necessary to account for the missingbody component(s) when estimating IBW.Table: Percent of Body Weight Contributedby Specific Body PartsBody PartPercentageTrunk w/o limbs50.0Hand0.7Forearm with hand2.3Forearm without hand1.6Upper arm2.7Entire arm5.0Foot1.5Example: 80 year old man, amputation of theleft lower leg, 1.72 m, 58 kgLower leg with foot5.91. Estimated body weight: Current body weight (1 - proportion for the missing leg)Lower leg without foot4.4Thigh10.1Entire leg16.058 (kg) [1-0.059] 58 (kg) 0.941 61.6 kg2. Calculate BMI:Estimated body weight / body height (m)261.6 [1.72 x 1.72] 20.8References cited:Lefton, J., Malone A. Anthropometric Assessment. InCharney P, Malone A, eds. ADA Pocket Guide to NutritionAssessment, 2nd edition. Chicago, IL: American DieteticAssociation; 2009:160-161.Osterkamp LK., Current perspective on assessmentof human body proportions of relevance to amputees,J Am Diet Assoc. 1995;95:215-218.Screen and intervene. Nutrition can make a difference.13
Appendix 4 Measuring calf circumference1. The subject should be sitting with the left leghanging loosely or standing with their weightevenly distributed on both feet.2. Ask the patient to roll up the trouser leg touncover to calf.3. Wrap the tape around the calf at the widestpart and note the measurement.4. Take additional measurements above andbelow the point to ensure that the firstmeasurement was the largest.5. An accurate measurement can only beobtained i
Nutrition Screening as as. 2 Introduction Mini Nutritional Assessment – Short Form (MNA -SF) The MNA -SF is a screening tool to help identify elderly patients who are malnourished or at risk of malnutrition. This User Guide will assist you in completing the MNA -SF accurately and consistently.
4.4 Emerging and re-emerging infections 43 4.5 Clinically insignificant transfusion-transmissible infections 44 5 Blood screening, quarantine and release 45 5.1 Blood screening process 45 5.2 Approaches to blood screening 45 5.3 Pooling for serological assays 47 5.4 Sequential screening 47 5.5 Blood screening and diagnostic testing 48 5.6 Emergency screening 48 5.7 Screening plasma for .
healthcare team may complete nutrition screening. Nutrition screening should be completed upon admission to a healthcare setting and when nutrition risk is triggered, there should be an automatic referral to the registered dietitian (RD) or the nutrition care team for a comprehensive nutrition assessment.
The Nutrition Care Process is defined in four steps: 1. Nutrition Assessment 2. Nutrition Diagnosis 3. Nutrition Intervention 4. Nutrition Monitoring & Evaluation The first component of the “Nutrition Assessment” is a screening of residents for those at risk for nutrition problems and is a candidate for further intervention. One of the
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Nutrition during a woman's life From: ACC/SCN and IFPRI. 4th Report on the World Nutrition Situation: Nutrition Throughout the Life Cycle. Geneva: WHO, 2000. Nutrition during a woman's life From: ACC/SCN and IFPRI. 4th Report on the World Nutrition Situation: Nutrition Throughout the Life Cycle. Geneva: WHO, 2000.
Nutrition Evaluation: the systematic comparison of current findings with the previous status, nutrition intervention goals, effectiveness of overall nutrition care, or a reference standard Nutrition Care Outcomes: the results of nutrition care that are directly related to the nutrition diagnosis and the goals of the intervention plan
Running a Resume Screen Page 2 of 17 version 1.2 (updated 6/11/21) Note: If there were screening levels before the Resume Screening (Online and/or Manual Screening), all screening must be complete prior to running the Resume Screening. 1. Go to the Applicants tab within the Job Opening. 2. If the Resume Screen is the only screening level,
Nutrition Screening for Infants and Young Children with Special Health Care Needs: Spokane County, Washington, October 2008 Parents, guardians, or caregivers completed the Nutrition Screening Form during the intake visit with the Family Resources Coordinators in Spokane County from April 1, 2004 to March 31, 2007.
