C URRENT O PINION Mini Nutritional Assessment Emanuele Cereda Purpose of review To summarize recent evidences and advances on the implementation and the use of the Mini Nutritional Assessment (MNA). Recent findings Despite being introduced and validated for clinical use about 20 years ago, the MNA has recently received new attention in order to more widely disseminate among healthcare professionals the practice of a systematic nutritional screening and assessment of the old patient. Particularly, the structure has been implemented to face the difficulties in having the patients contributing to the assessment and to reduce further the time required to complete the evaluation. Recent data also confirm that in older populations prevalence of malnutrition by this tool is associated with the level of dependence. The rationale of nutritional assessment is to identify patients candidate to nutritional support. However, the sensitivity of the MNA is still debated because it has been associated with a high-risk ‘overdiagnosis’ and the advantages of a positive screening need to be assessed both in terms of outcome and money saving. Summary The MNA is a simple and highly sensitive tool for nutritional screening and assessment. The large mass of data collected and the diffusion among healthcare professionals clearly support its use. However, the cost- effectiveness of interventions based on its scoring deserves investigation. Keywords elderly, malnutrition, Mini Nutritional Assessement, Mini Nutritional Assessment Short Form, nutritional screening tools, risk of malnutrition INTRODUCTION The Mini Nutritional Assessment (MNA) is the most widespread tool for nutritional screening and assess- ment 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. THE NEED TO SCREEN THE ELDERLY PATIENT 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 com- ponents 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 Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy Correspondence to Emanuele Cereda, MD, PhD, Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100 Pavia, Italy. Tel: +39 0382 501615; fax: +39 0382 502801; e-mail: e.cereda@smatteo.pv.it Curr Opin Clin Nutr Metab Care 2012, 15:29–41 DOI:10.1097/MCO.0b013e32834d7647 1363-1950 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins www.co-clinicalnutrition.com REVIEW