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Mini Nutritional Assessment

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

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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