MINI NUTRITIONAL ASSESSMENT MNA® A fee Sages Inter ipa th form iy at he Friis th in, dl tras eB id ops He tee anbensinent the Mainutrition indicator Score. ANTHROPOMETRIC ASSESSMENT 4 Boxy Mass indsx (Bl) (weighting) / (height in nF Pola 12, Selected comsumption merkers for protein intake ee eawet 2Osaiis Atleast one serving of diy prcicts (rik, : eeribest soos, equ) paring? yes oC) caine o + Twa amare sarangs of agus or 2998 pa week? Lee yes nell ‘twa Seopa “hate sto ea abo yes =O. pons b MAC 29522 = 05 paints: b.2: = 0.5 por Chace = Ope oo Citys "10pm 3. Calf ciroumferenoe (CC inom 13. Consumes two or more sanings of fruits or OG<31 = Opals b. GOES =1 point Oo \ogetables por day? qd 4, Weight loss dunng last 3 moins esha Bayne pont = 2 ain gern ‘ig (@6lbs) = Opoints “4. Has food intake declined over tha past oe fot knw = T point -morihs due Lo toss of appetite, cayestive protiorres, igh as been tend hy having or swatonrg GPcuts? (22 and 6 lbs} = 2 points a meow =O pois d noweight hes =3pcints Oo 'b moderate oss of appete = 1 point GENERAL ASSESSMENT cole efalia =2pehis a 6. ves edependeaty (pot arurting home or hoe) © Name ayitenoay ano =0 points byes =1 point o a leesthan3 cope paints 3 to Sug ‘0.5 points 6. Takes mare tan 3 presergion i . a ta o Dee hm dati reo D Smmetenbcqe 18pm oo 18. Node cfading ee a Unabletoeatwihautassttarce =O pats Sys Onan hos aonis Q Basti wmsoe sity = prt cS 6 sated wut any pclam——= 2 pis og 8, Mobily a bad chal bound =O ponte SELF ASSESSMENT ae aa 17. Do fey view themselves as having rutntional problems? : fa riggr maturtion = Opes 2 g0Es oat Sorts oO (b, does nat know or moderata malnutrition = f point @, Neurepeythotogical problems 6. na putifional probleen =2ecints | SS Sree on 1B. m compansan with othar penple of te same ape, how cen = ipo {otheyennsitor for hash sats? no psyeholgcal ctioms = 2pois er cate 1 Pen we sina 5 Basin =n a yes=0 ‘Bn = { point as a = £0 points es Dros o bt = 20 pois DIETARY ASSESSMENT 7 Fovany Mima amabe at ASSESSMENT TOTAL (nar. 20cinsp 4 meal =6 pots b. 2meals = 1 point cB meals «2 points o et: ney Vela Boe Gaby I Md Mit Aan Ape ‘eonegr Bpenar Fea" ven ‘©1004 Meatoc Lit (Nenlé Reveerch Canter) Resta Canicat Nutrition