Dysphagia Knowledge Hub — 吞嚥困難知識庫

MNA-SF: Mini Nutritional Assessment Short Form

Overview

Malnutrition and dysphagia are deeply intertwined in older adults. Texture-modified diets — prescribed to reduce aspiration risk — can paradoxically worsen nutrition by reducing food palatability, variety, and caloric density. The MNA-SF (Mini Nutritional Assessment Short Form) provides a rapid, validated nutritional screen that should be applied to every older patient with known or suspected dysphagia.

Developed by Guigoz et al. and subsequently refined, the MNA-SF is the abbreviated version of the full 18-item MNA. It has been validated across nursing home, hospital, and community settings and is recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) as the preferred nutritional screening tool for older adults.

---

The 6 Items

A. Decline in food intake over 3 months (due to loss of appetite, digestive problems, chewing or swallowing difficulties):

• 0 = Severe decrease
• 1 = Moderate decrease
• 2 = No decrease

B. Weight loss in the last 3 months:

• 0 = Weight loss >3 kg
• 1 = Does not know
• 2 = Weight loss 1–3 kg
• 3 = No weight loss

C. Mobility:

• 0 = Bed or chair bound
• 1 = Able to get out of bed/chair but does not go out
• 2 = Goes out

D. Psychological stress or acute disease in the last 3 months:

• 0 = Yes
• 2 = No

E. Neuropsychological problems:

• 0 = Severe dementia or depression
• 1 = Mild dementia
• 2 = No psychological problems

F1. BMI (kg/m²):

• 0 = BMI <19
• 1 = BMI 19–21
• 2 = BMI 21–23
• 3 = BMI ≥23

F2. Calf circumference (CC) in cm (if BMI unavailable):

• 0 = CC <31 cm
• 3 = CC ≥31 cm

Maximum score: 14 points

---

Scoring and Interpretation

MNA-SF Score	Nutritional Status
12–14	Normal nutritional status
8–11	At risk of malnutrition
0–7	Malnourished

Patients scoring ≤11 should receive the full 18-item MNA assessment and dietitian review.

---

The Dysphagia-Malnutrition Link

Dysphagia contributes to malnutrition through multiple mechanisms:

1. Reduced intake volume: Slow eating due to effortful swallowing leads to early satiety and incomplete meals.
2. Diet monotony: Texture modification eliminates many nutrient-dense foods (nuts, raw vegetables, certain meats).
3. Caloric dilution: Thickened liquids have higher volume but often lower caloric density than solid foods they replace.
4. Social withdrawal: Eating difficulties in social contexts reduce meal frequency.
5. Increased energy expenditure: The effort of dysphagia rehabilitation and chronic pulmonary infection (aspiration pneumonia) increases metabolic demands.

Studies report malnutrition rates of 30–60% in hospitalised older adults with dysphagia (Carrión et al., 2015; DOI: 10.1016/j.clnu.2015.01.014).

---

Integration with Dysphagia Assessment

MNA-SF should be performed:

• At admission for all patients ≥65 years
• When dysphagia is newly identified
• When texture modification is prescribed or intensified
• Monthly in nursing home residents with dysphagia
• When the patient reports weight loss, decreased appetite, or meal refusal

When MNA-SF ≤11:

• Refer to dietitian for full nutritional assessment
• Calculate caloric and protein requirements (target: 30–35 kcal/kg/day; 1.2–1.5 g protein/kg/day in older adults)
• Consider energy-dense texture-modified products
• Evaluate need for oral nutritional supplements (ONS) or enteral nutrition

---

Practical Considerations in Dysphagia

• Weight measurement: Use actual weight where possible; if the patient is bedbound, use arm span or demi-span to estimate height, or use validated prediction equations for BMI estimation.
• Calf circumference: Use CC as the F-item substitute when weighing is impractical (bedbound, oedematous limbs). CC <31 cm correlates with sarcopenia and poor prognosis.
• Proxy reporting: For patients with severe dementia or communication impairment, interview the primary caregiver for items A–E.
• Action threshold: Even MNA-SF 8–11 (“at risk”) in a dysphagic patient warrants proactive dietitian input — do not wait for frank malnutrition to develop.

---

References

1. Guigoz Y, et al. (1994). Mini Nutritional Assessment: a practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol, 4(Suppl 2):15–59.
2. Rubenstein LZ, et al. (2001). Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci, 56(6):M366–72. PMID: 11382797
3. Carrión S, et al. (2015). Complications of oropharyngeal dysphagia: malnutrition and aspiration pneumonia. Clin Nutr, 34(6):1267–72. DOI: 10.1016/j.clnu.2015.01.014
4. Cederholm T, et al. (2017). ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr, 36(1):49–64. DOI: 10.1016/j.clnu.2016.09.004