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Mini Nutritional Assessment

Complete the screen by filling in the boxes with the appropriate answers.
Complete the screen by filling in the boxes with the appropriate answers.
Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties?
Severe decrease in food intake
Moderate decrease in food intake
No decrease in food intake
Weight loss during the last 3 months
Weight loss greater than 3kg (6.6lbs)
Does not know
weight loss between 1 and 3kg (2.2 and 6.6 lbs)
no weight loss
Mobility
Bed or chair bound
Able to get out of bed / chair but does not go out
Able to go out
Has suffered psychological stress or acute disease in the past 3 months?
Yes
No
Neuropsychological problems
Severe dementia or depression
Mild dementia
No psychological problems
Body Mass Index (BMI) = weight in kg / (height in m) 2
BMI less than 19
BMI 19 to less than 21
BMI 21 to less than 23
BMI 23 or greater
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