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AGEING: BIOLOGY AND NUTRITION: Edited by Ronni Chernoff and Tommy Cederholm

Mini Nutritional Assessment

Cereda, Emanuele

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Current Opinion in Clinical Nutrition and Metabolic Care: January 2012 - Volume 15 - Issue 1 - p 29-41
doi: 10.1097/MCO.0b013e32834d7647
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The Mini Nutritional Assessment (MNA) is the most widespread tool for nutritional screening and assessment due to the ease of use and the feasibility in any clinical care setting. Despite being introduced and validated for clinical use about 20 years ago, this tool has recently received new attention and has been the object of reappraisals in order to disseminate more widely the practice of a systematic nutritional screening of the old patient. In this scenario, the aim of this review is to summarize recent evidences and advances on the implementation and the use of this instrument.


Looking at the demographic time trends, the ratio of people aged over 65 years is considerably growing, rising up in the past decade from 18 to 20% of total population (from 2 to 3% for those >85 years old) with a mean lifetime increase of 2 years in both sexes [1].

Nutritional disorders are of specific relevance for the elderly. Aging is intrinsically associated with a progressive reduction in muscle mass and more widely with a loss of metabolically active components of the body which in turn result not only in loss of functionality but also in worse outcome [2▪,3▪,4▪▪]. This increased vulnerability to stressors has led experts in to seek for a clinical definition of ‘frailty syndrome’, a condition that is believed to be a continuum situated between normal aging and end-stage disability. In regard to this, no consensus was achieved but an agreement to consider frailty a predisability stage was found [5,6]. The MNA has been proposed as a useful alternative tool to identify frail patients [5] and, interestingly, previous research has shown that in institutionalized patients at risk of malnutrition most of the association between nutritional and functional status (by MNA and Barthel index, respectively) is explained by some of the key features of frailty such as weight loss and sarcopenia [7].

Box 1
Box 1:
no caption available

The proneness of aging people to nutritional derangements is likely to be multifactorial and a list of causative factors has been elegantly resumed in the ‘9 Ds’ and the practical acronym ‘MEALS ON WHEELS’ (Table 1) [8,9].

Table 1
Table 1:
Summary of factors potentially involved in nutritional derangements

Indeed, the work of international societies and ad-hoc study groups is a timely and rationalized effort to improve the patient's outcome. Diseases have changed from acute to chronic ones. Similarly, medicine has turned to a preventive approach from a curative one. Accordingly, increased knowledge and awareness, as well as improved practice should theoretically result in early diagnosis of risk conditions that, being more likely to be reversible, allow planning of effective interventions.


It is highly recommended that a screening tool fits best to the population object of evaluation [10]. Due to the potentially multifactorial origin of nutritional risk in the elderly it appears that the MNA properly addresses this requirement. Structured in 18 questions grouped in four rubrics (anthropometry, general status, dietary habits, and self-perceived health and nutrition states), the MNA provides a multidimensional assessment of the patient (Table 2) [11,12].

Table 2
Table 2:
MNA scoring system

It was initially developed as a one-step evaluation procedure, using as principal reference criteria the physician-rated nutritional status and a full nutritional assessment including anthropometric measures, biochemical parameters, dietary intake and functional variables such as cognition (by Mini-Mental State Examination) and activities of daily living (general and instrumental). After its completion, the final score (a maximum of 30 points) allows grading the nutritional status according to clearly defined thresholds: scores above 24, good status; scores 23.5–17, risk of malnutrition; scores below 17, malnutrition. The main features targeted during this phase of design and validation were the reliability, the simplicity, the speed of execution and the acceptability by the patient [11]. Despite the good agreement with the physician's judgement, which still remains the gold standard of nutritional assessment, the initial researchers and the scientific community worked hard to bring further improvements and in the following years the tool was the object of different reappraisals. The key passages of this process are summarized in Table 3.

Table 3
Table 3:
Key passages of MNA implementation history

After development and validation, the tool was then implemented as a more practical two-step evaluation process. Although the full MNA can be completed in 15–20 min, in cognitively impaired people the assessment may require more time and in some cases answers are difficult to obtain. Moreover, in acute care settings time-consuming procedures may not be performed. A reanalysis of the initial database by Rubenstein et al.[13] allowed a selection of six questions (step 1) to be used as the basic screening procedure [MNA Short Form (MNA-SF)], taking up to 5 min, but that would nevertheless retain the same accuracy of the original tool. To this purpose physician's clinical rating was again taken as reference standard. However, scoring the patients to a maximum of 14 points, the initial version of MNA-SF allowed identifying only risk of malnutrition (scores <12) so that the completion of full MNA (step 2) is required for confirmation and a diagnosis of malnutrition at risk or overt malnutrition. Moreover, this tool appeared more appropriate for the community-dwelling elderly and less efficient than the full version for nursing home residents [12].

The issue of short time burden has been always considered a mainstay for the design of nutritional screening procedures. In regard to this, the introduction of MNA-SF has provided significant advances in the dissemination of nutritional screening as an integral part of routine care. However, researchers have recently considered that some more could be done to improve the utility and the efficiency of this tool. Performing a laborious and commendable pooled datasets analysis, in 2009 the MNA-International Group has implemented the MNA-SF [14] in order to allow the identification of three nutritional status categories as the case of the full MNA (forms available for free download at: To this purpose cut-points of the revised MNA-SF were optimized by comparison with those of full MNA obtaining a sensitivity of 89.3% and a specificity of 94.3% for nutritional risk (score <12) and malnutrition (score <8), respectively. Moreover, the group tested the other anthropometric parameters included in the full version (calf and mid-arm circumferences) to allow the completion independent of the potentially time-consuming and less accessible evaluation of BMI. Accordingly, calf circumference was demonstrated a good substitute of BMI. Particularly, it was found that a cut-point of 11 had a sensitivity of 90.2% and a specificity of 76.2% for nutritional risk, whereas a cut-point of 8 had a sensitivity of 88.3% and a specificity of 88.7% for malnutrition [14]. Indeed, these results are promising and looking at the mass of data available for the full MNA and the first version of the MNA-SF there are only a few things that still need to be done to complete the validation. The first is a cross-validation study that reasonably takes into account its application in different healthcare settings, whereas the second is an evaluation of its prognostic value in relation to different outcomes. It could not be excluded that the group is already working on these research issues.


The MNA has been widely used in clinical research and a consistent mass of data is now available. Several investigators all over the world have tested its application and, in regard to this, attention has been primarily focused on the healthcare setting (community, home care/outpatients, acute hospital care, subacute and rehabilitation care, institutions) and the type of patients assessed (e.g. cognitively impaired and/or the frail elderly). Given the multidimensional approach, the prevalence picture of nutritional conditions provided by the MNA appears in some measure able to reflect the nutritional features (e.g. BMI, weight loss, dietary habits) and the dependence level of the patients assessed across different settings [12,15]. This consideration is a further confirmation of its utility as a tool for grading nutritional derangements.

In this context, it raises attention towards the recent retrospective pooled analysis of previously published datasets performed by the MNA International Group [16▪▪] and Soini et al.[17▪▪] in order to provide a perspective of malnutrition frequency in different standards of care.

Extensive reviews of literature on the use of the MNA have been previously performed. The first of these by Guigoz [12] and Vellas et al.[18] date back to 2006 and include all published articles until early 2006. Particularly, in the review by Guigoz [12] an interesting estimation of the prevalence of malnutrition and risk of malnutrition across the studies according to the different settings was provided. The systematic evaluation of literature was then continued until early 2008 by Bauer et al.[15] but no updated estimation on the prevalence was given. In the present review, literature (English full-text) on the MNA published until June 2011 has been additionally assessed after searching through PubMed and using the MNA Literature Database of the Nestlè Nutrition Institute (available at: A detailed description of the articles providing unpublished prevalence data is listed in Table 4[7,17▪▪,19–26,27▪,28–56,57▪,58–67,68▪,69–121]. Therefore, data extracted were analysed together with those already reviewed in order to provide an updated picture of malnutrition prevalence. Only those observational studies providing setting-specific data on elderly patients according to three categories of nutritional status (either by full or revised short-form MNA) were considered. The attention was focused on the following settings: acute care (hospital); subacute/rehabilitation care; institutions (nursing home, long-term care and sheltered housing); outpatients/home-care; community. Accordingly, prevalence of malnutrition and its risk were

  1. acute care (69 studies, n = 17 775 elderly), 23.4% (range 0–68%) and 49.4% (range 8–93%);
  2. subacute/rehabilitation care (9 studies, n = 3724 elderly), 31.0% (range 6–46%) and 54.0% (range 46–67%);
  3. institutions (73 studies, n = 20 410 elderly), 27.2% (range 0–61%) and 52.1% (range 0–82%);
  4. outpatients/home-care (45 studies, n = 12 386 elderly), 7.7% (range 0–38%) and 39.6% (range 7–75%);
  5. community-dwelling elderly (53 studies, n = 50 957 elderly) 4.2% (range 0–26%) and 27.4% (range 0–76%); including three studies focusing on rural communities from developing countries and reporting significantly higher prevalence of malnutrition and its risk [57▪,68▪,102].
Table 4-a
Table 4-a:
Prevalence of malnutrition and risk of malnutrition according to the MNA (literature review from early 2008 through mid-2011)
Table 4-b
Table 4-b:
Prevalence of malnutrition and risk of malnutrition according to the MNA (literature review from early 2008 through mid-2011)
Table 4-c
Table 4-c:
Prevalence of malnutrition and risk of malnutrition according to the MNA (literature review from early 2008 through mid-2011)

As observed by Guigoz [12], these estimates appear significantly associated with the expected level of dependence (Fig. 1). Along with this, as previously reported for the Geriatric Nutritional Risk Index (GNRI) tool [10], the MNA seems to describe the potential patient's ‘journey’ across the different healthcare settings. Community-dwelling elderly are generally characterized by less need for help in daily living when compared to outpatients and patients at home-care services. This need significantly increases in those admitted to hospitals. Acute diseases are likely to be responsible for iporexia, weight loss and progressive reduction in BMI and skeletal muscle mass due to increased catabolism and inflammation. Sarcopenia and low body weight lead also to severe disability, whereas psychological distress deriving from acute events, as well as overt depression may also contribute to the worsening of global health and its self-perception. In addition, also the poor nutritional routines and attitudes among healthcare professionals may be involved in the process of nutritional deterioration [122]. Accordingly, it does not surprise that patients discharged from acute care are characterized by prolonged recovery. This is reflected by the necessity to be admitted to postacute care or to be included in rehabilitation programmes. In many other cases, elderly patients do not ever come back home, if this was the provenience, and institutionalization is a forced choice. In this ‘journey’ the nutritional status of the patient is likely to worsen. However, institutions should be considered a setting per se above all due to the heterogeneity of the resident population [12,15], particularly for the prevalence of certain diseases (e.g. dementia) or the setting of provenience of the patients.

Prevalence of malnutrition (plot A) and risk of malnutrition (plot B) according to the full MNA and the level of dependence (weighted mean of the studies retrieved [●]).


National and international nutrition societies are intensively engaged in the fight against malnutrition. In regard to this, the use of screening procedures is one of the pillars of prevention or even early recognition. Due to its feasibility and the reduced skills and time required for its completion, the MNA is a true candidate for becoming integral part of routine care assessments and its use is now recommended by the European Society of Clinical Nutrition and Metabolism (ESPEN), the International Association of Gerontology and Geriatrics (IAGG) and the International Academy Nutrition and Aging (IANA) [123,124▪]. Unfortunately, it should be said candidate because, despite the great efforts made in the past 30 years, malnutrition still goes underdiagnosed and undertreated.

Indeed, the background of the MNA is solid. The tool has been designed specifically for elderly patients. It allows grading nutritional status in an univoque way and in a timely manner having the tool itself a high inter-rater reliability [12] and clearly defined thresholds. Thus, it appears appropriate for decision-making and guiding nutritional intervention. To stimulate and increase the diffusion of systematic nutritional assessment among clinicians, apart from the aforementioned historical improvements, the tool has been validated in several ethnicities and ethnic-specific anthropometric cut-points have been set up. Along with this, the MNA has been translated in several languages and a free downloadable iPhone application is now available for a bedside use in any setting (download available at:

Finally, a main question on the use of the MNA concerns who should apply it. The tool has been designed to be theoretically completed by everyone, including the patients upon appropriate interviewing. However, the accuracy and the reliability of results have been the object of discussion particularly when nursing home residents or hospital inpatients are assessed due to the frequent coexistence of cognitive and linguistic disabilities or the lack of consciousness. This issue has been recently addressed by Kaiser et al.[87▪▪], who have demonstrated that the objective application by the nursing staff is superior and better correlated with mortality (outcome) compared to one-on-one interviews of the residents.


Despite highlighting several advantages and strengths of the MNA, some aspects have also been the object of debate. However, as discussed above, two potential limitations have been addressed by recent research. The time required for its completion, which has brought this tool to be challenged by others such as the Malnutrition Universal Screening Tool (MUST) or the Nutritional Risk Score 2002 (NRS-2002), is no longer a problem. Building a shortened version by reducing the number of ‘don’t know’ answers (MNA-SF) [13], making its scoring independent of BMI measurement and validating it for the grading of nutritional status [14] have made the tool very suitable for any setting and systematic screening and assessment. Also the question of who should complete the tool has been resolved. Accordingly, it has been suggested or even recommended that this should be performed by the nursing staff or the caregiver. However, an essential precondition is the thorough knowledge of the different aspects of the residents’ life [87▪▪]. This aspect has been emphasized by a recent study by Cereda et al.[125▪]. Despite this issue not being clearly discussed, it has been observed that in newly institutionalized elderly (mainly coming from hospital), nutritional status by the full MNA was not associated with mortality. It was also noteworthy that the prevalence of impaired nutritional status was up to 90% [125▪], thus making the detection of differences in the association with outcome between categories of nutritional status difficult. Accordingly, in some cases, the use of other tools (e.g. the GNRI) should be considered. Indeed, the aims of nutritional screening are to:

  1. identify patients malnourished or at risk of malnutrition;
  2. identify patients at risk of developing nutrition-related complications; and
  3. identify patients who can benefit from nutritional intervention.

In respect to these purposes, some comments should be provided. The MNA is a highly sensitive tool. This applies not only to nutritional status but also to outcome [12,15,126]. However, a high sensitivity is required for screening purposes, whereas a high specificity is required for diagnosis and this tool has been associated with a high risk of ‘overdiagnosis’ (low specificity) [126]. This aspect may have important implications from an economical point of view, because the advantages of a positive screening, and of treatment, need to be investigated through pharmaco-economic studies taking cost-effectiveness among the primary outcomes. Reimbursability of nutritional interventions by sip feeding is still a critical point and the situation is heterogeneous among different countries. However, the importance of early intervention should be emphasized, because the efficacy of treatment in the presence of mild nutritional deterioration is likely to be higher and could theoretically allow the prevention of several complications and cost burden [127].


‘As easy as MNA’ is now considered the business card of the MNA. Specifically designed and validated for the elderly patient, the MNA has been the object of consistent investigation that, revealing potential limitations on its feasibility and systematic application, has allowed a significant improvement of its structure and of nutritional screening and assessment processes. However, the strength of being highly sensitive in the identification of patients at risk of malnutrition and of nutrition-related complications has been a source of criticism because the risk of ‘overdiagnosing’ could not be counterbalanced by cost-effective early nutritional interventions. Future research should address this lack of evidence by potentially also taking into account the application setting as literature suggests that protein-calorie supplementation is effective in improving the outcome only of the malnourished elderly in hospital [128].

In some cases, however, the use of the MNA should be integrated with that of other tools. It seems likely that the search for a comprehensive and universal tool is never ended but it could not also be denied that the value of the MNA for the moment has no peer.


A special thank to Dr Pedrolli Carlo (Trento Hospital) for the assistance in data review.

Conflicts of interest

E.C. has received consultancy honoraria and investigator grants from Nutricia Italia for activities outside the present work.

There are no conflicts of interest.


Papers of particular interest, published within the annual period of review, have been highlighted as:

  • ▪ of special interest
  • ▪▪ of outstanding interest

Additional references related to this topic can also be found in the Current World Literature section in this issue (pp. 93–94).


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In this study, it has been demonstrated that prevalence of malnutrition in community-dwelling elderly living in a rural country is higher than that of well developed ones, thus supporting the MNA is appropriate in different socio-economic conditions.

69. Vischer UM, Perrenoud L, Genet C, et al. The high prevalence of malnutrition in elderly diabetic patients: implications for antidiabetic drug treatments. Diabet Med 2010; 27:918–924.
70. Volkert D, Saeglitz C, Gueldenzoph H, et al. Undiagnosed malnutrition and nutrition-related problems in geriatric patients. J Nutr Health Aging 2010; 14:387–392.
71. Wang G, Wan Y, Cheng Q, et al. Malnutrition and associated factors in Chinese patients with Parkinson's disease: results from a pilot investigation. Parkinsonism Relat Disord 2010; 16:119–123.
72. Amer MS, Mousa SM, Abdel Rahman TT, Saber HG. Malnutrition and its risk factors in nursing home residents in Cairo. J Am Geriatr Soc 2009; 57:1716–1718.
73. Bernabeu-Wittel M, Jadad A, Moreno-Gaviño L, et al. Peeking through the cracks: an assessment of the prevalence, clinical characteristics and health-related quality of life (HRQoL) of people with polypathology in a hospital setting. Arch Gerontol Geriatr 2010; 51:185–191.
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With this research it has been demonstrated that the application of the MNA by nursing staff in a long-term care setting is superior and better correlated with mortality (outcome) compared to one-on-one interviews of the residents. Accordingly, the completion by the caregiver should be recommended.

88. Lei Z, Qingyi D, Feng G, et al. Clinical study of mini-nutritional assessment for older Chinese inpatients. J Nutr Health Aging 2009; 13:871–875.
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92. Salva A, Andrieu S, Fernandez E, et al. NutriAlz Group. Health and nutritional promotion program for patients with dementia (NutriAlz Study): design and baseline data. J Nutr Health Aging 2009; 13:529–537.
93. Serra-Prat M, Palomera E, Clave P, Puig-Domingo M. Effect of age and frailty on ghrelin and cholecystokinin responses to a meal test. Am J Clin Nutr 2009; 89:410–1417.
94. Smoliner C, Norman K, Wagner KH, et al. Malnutrition and depression in the institutionalised elderly. Br J Nutr 2009; 102:1663–1667.
95. Tsai AC, Chang TL, Chen JT, Yang TW. Population-specific modifications of the short-form Mini Nutritional Assessment and Malnutrition Universal Screening Tool for elderly Taiwanese. Int J Nurs Stud 2009; 46:1431–1438.
96. Tsai AC, Chou YT, Chang TL, et al. A modified Mini Nutritional Assessment without BMI can effectively assess the nutritional status of neuropsychiatric patients. J Clin Nurs 2009; 18:1916–1922.
97. Tsai AC, Ku PY, Tsai JD. Population-specific anthropometric cutoff standards improve the functionality of the Mini Nutritional Assessment without BMI in institutionalized elderly in Taiwan. J Nutr Health Aging 2008; 12:696–700.
98. Tsai AC, Shih CL. A population-specific Mini-Nutritional Assessment can effectively grade the nutritional status of stroke rehabilitation patients in Taiwan. J Clin Nurs 2009; 18:82–88.
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100. Wengstrom Y, Wahren LK, Grodzinsky E. Importance of dietary advice, nutritional supplements and compliance for maintaining body weight and body fat after hip fracture. J Nutr Health Aging 2009; 13:632–638.
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102. Aliabadi M, Kimiagar M, Ghayour-Mobarhan M, et al. Prevalence of malnutrition in free living elderly people in Iran: a cross-sectional study. Asia Pac J Clin Nutr 2008; 17:285–289.
103. Amici A, Baratta A, Linguanti A, et al. The Marigliano-Cacciafesta polypathological scale: a tool for assessing fragility. Arch Gerontol Geriatr 2008; 46:327–334.
104. Cabré M, Serra-Prat M, Force L, et al. Functional status as a risk factor for mortality in very elderly patients with pneumonia. Med Clin (Barc) 2008; 131:167–170.
105. Carlsson M, Gustafson Y, Eriksson S, Håglin L. Body composition in Swedish old people aged 65–99 years, living in residential care facilities. Arch Gerontol Geriatr 2009; 49:98–107.
106. Chevalier S, Saoud F, Gray-Donald K, Morais JA. The physical functional capacity of frail elderly persons undergoing ambulatory rehabilitation is related to their nutritional status. J Nutr Health Aging 2008; 12:721–726.
107. Cuervo M, Ansorena D, García A, et al. Food consumption analysis in Spanish elderly based upon the mini nutritional assessment test. Ann Nutr Metab 2008; 52:299–307.
108. De Marchi RJ, Hugo FN, Hilgert JB, Padilha DM. Association between oral health status and nutritional status in south Brazilian independent-living older people. Nutrition 2008; 24:546–553.
109. Ferreira LS, Nascimento LF, Marucci MF. Use of the mini nutritional assessment tool in elderly people from long-term institutions of southeast of Brazil. J Nutr Health Aging 2008; 12:213–217.
110. Gil-Montoya JA, Subirá C, Ramón JM, González-Moles MA. Oral health-related quality of life and nutritional status. J Public Health Dent 2008; 68:88–93.
111. Hengstermann S, Laemmler G, Hanemann A, et al. Total serum homocysteine levels do not identify cognitive dysfunction in multimorbid elderly patients. J Nutr Health Aging 2008; 12:411–416.
112. Iizaka S, Tadaka E, Sanada H. Comprehensive assessment of nutritional status and associated factors in the healthy, community-dwelling elderly. Geriatr Gerontol Int 2008; 8:24–31.
113. Kulnik D, Elmadfa I. Assessment of the nutritional situation of elderly nursing home residents in Vienna. Ann Nutr Metab 2008; 52 (Suppl 1):51–53.
114. Miller M, Wong WK, Wu J, et al. Upper-arm anthropometry: an alternative indicator of nutritional health to body mass index in unilateral lower-extremity amputees? Arch Phys Med Rehabil 2008; 89:2031–2033.
115. Odencrants S, Ehnfors M, Ehrenberg A. Nutritional status and patient characteristics for hospitalised older patients with chronic obstructive pulmonary disease. J Clin Nurs 2008; 17:1771–1778.
116. Odlund Olin A, Koochek A, Cederholm T, Ljungqvist O. Minimal effect on energy intake by additional evening meal for frail elderly service flat residents: a pilot study. J Nutr Health Aging 2008; 12:295–301.
117. Pérez-Llamas F, López-Contreras MJ, Blanco MJ, et al. Seemingly paradoxical seasonal influences on vitamin D status in nursing-home elderly people from a Mediterranean area. Nutrition 2008; 24:414–420.
118. Soto ME, Nourhashemi F, Arbus C, et al. Special acute care unit for older adults with Alzheimer's disease. Int J Geriatr Psychiatry 2008; 23:215–219.
119. Tsai AC, Ho CS, Chang MC. Assessing the prevalence of malnutrition with the Mini Nutritional Assessment (MNA) in a nationally representative sample of elderly Taiwanese. J Nutr Health Aging 2008; 12:239–243.
120. 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 2008; 100:152–158.
121. Wikby K, Ek AC, Christensson L. The two-step Mini Nutritional Assessment procedure in community resident homes. J Clin Nurs 2008; 17:1211–1218.
122. Cereda E, Lucchin L, Pedrolli C, et al. Nutritional care routines in Italy: results from the PIMAI (Project: Iatrogenic MAlnutrition in Italy) study. Eur J Clin Nutr 2010; 64:894–898.
123. Kondrup J, Allison SP, Elia M, et al. Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening. Clin Nutr 2003; 22:415–421.
Task Force on Nutrition and Ageing of the IAGG and the IANA. Nutritional assessment of residents in long-term care facilities (LTCFs): recommendations of the task force on nutrition and ageing of the IAGG European region and the IANA. J Nutr Health Aging 2009; 13:475–483.

This consensus study reports an updated list of recommendations for managing nutritional management of elderly people in long-term cares.

Cereda E, Pedrolli C, Zagami A, et al. Nutritional screening and mortality in newly institutionalized elderly: a comparison between the Geriatric Nutritional Risk Index and the Mini Nutritional Assessment. Clin Nutr (in press).

With this prospective study, the authors have demonstrated that in newly institutionalized elderly nutritional risk by the Geriatric Nutritional Risk Index but not nutritional status by the Mini Nutritional Assessment is associated with mortality. Accordingly, in this patient population the use of the GNRI is suggested.

126. Beck AM, Holst M, Rasmussen HH. Efficacy of the Mini Nutritional Assessment to predict the risk of developing malnutrition or adverse health outcomes for old people. e-SPEN 2008; 3:e102–e107.
127. Darmon P, Lochs H, Pichard C. Economic impact and quality of life as endpoints of nutritional therapy. Curr Opin Clin Nutr Metab Care 2008; 11:452–458.
128. Milne AC, Avenell A, Potter J. Meta-analysis: protein and energy supplementation in older people. Ann Intern Med 2006; 144:37–48.

elderly; malnutrition; Mini Nutritional Assessement; Mini Nutritional Assessment Short Form; nutritional screening tools; risk of malnutrition

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