British Journal of Nutrition

Full Papers

Population-specific Mini Nutritional Assessment effectively predicts the nutritional state and follow-up mortality of institutionalized elderly Taiwanese regardless of cognitive status

Alan C. Tsaia1a2 c1 and Pei-Yu Kua2

a1 Human Nutrition Program, Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA

a2 Graduate Institute of Long-Term Care, Asia University, 500 Liufeng Road, Wufeng, Taichung 41354, Taiwan


The study was conducted to determine the effectiveness of a modified Mini Nutritional Assessment (MNA) for assessing the nutritional status and predicting follow-up mortality of institutionalized elderly Taiwanese. The study was conducted in a large long-term care centre in central Taiwan. Trained interviewers assisted by the caregivers elicited sociodemographic data, healthcare and disease history, and answers to the MNA screen from each subject. One researcher performed all subjects' anthropometric measurements. Plasma albumin and cholesterol concentrations were determined. Results showed that the MNA without BMI, modified according to population-specific mid-arm circumference and calf circumference cut-points, effectively predicted the nutritional risk status of the elderly regardless of cognitive status. Substituting caregiver's assessments for self-viewed nutrition and health status (questions O and P of MNA) improved the predicting power of the tool in cognition-normal subjects. Results showed that 21·9 % of the elderly were malnourished, 59·2 % were at risk of malnutrition and 18·9 % were normal according to self-assessment whereas 14·2 % were malnourished, 59·2 % were at risk of malnutrition, and 26·6 % were normal according to caregiver's evaluation. The tool was also effective in predicting 12- and 6-month follow-up mortality in cognition-normal and cognition-impaired elderly, respectively. Results indicate that a population-specific MNA can effectively predict the nutritional status and 6-month follow-up mortality of elderly Taiwanese regardless of cognitive condition. Easier and wider application of the tool will enable early detection of emerging nutritional problems and timely intervention to prevent the development of severe malnutrition in the elderly.

(Received April 20 2007)

(Revised August 23 2007)

(Accepted September 06 2007)

(Online publication December 06 2007)


c1 Corresponding author: Dr Alan C. Tsai, fax +734 936 7283, email


Abbreviations: CC, calf circumference; MAC, mid-arm circumference; MNA, Mini Nutritional Assessment; WC, waist circumference