Public Health Nutrition

Assessment and methodology

Evaluation of the Mini Nutritional Assessment in the elderly, Tehran, Iran

Bahareh Amirkalalia1, Farshad Sharifia1, Hossein Fakhrzadeha1 c1, Mojde Mirarefina1, Maryam Ghaderpanahia1 and Bagher Larijania1

a1 Endocrine and Metabolism Research Center, Tehran University of Medical Sciences, Shariati Hospital, North Kargar Street, Tehran 1411713137, Islamic Republic of Iran


Objective To determine whether the Mini Nutritional Assessment (MNA) can screen and diagnose for malnutrition in the Iranian elderly.

Design The MNA was administered to all volunteers. Each patient underwent anthropometric and serum albumin measurements. Reliability, validity, sensitivity, specificity, positive- and negative-predictive values were estimated. To identify optimal threshold values for predicting malnutrition, receiver-operating characteristic curve analysis was performed for MNA scores.

Setting Kahrizak Charity Foundation (Tehran, Iran).

Subjects Two hundred and twenty-one consecutive elderly patients entered into the cross-sectional study. Amputees and patients with liver or renal disorders, oedema or any end-stage diseases were excluded.

Results According to MNA score, 3·2 % were malnourished, 43·4 % were at risk of malnutrition and 53·4 % were well nourished. The proportions in these categories according to ideal body weight and serum albumin were 2·3 %, 17·1 % and 80·6 %, respectively. Cronbach’s α coefficient (reliability) was 0·61. The correlations between total MNA score, anthropometric values and serum albumin (criterion-related validity) were all significant. There were significant differences in total MNA score between two BMI groups but not between two categories according to serum albumin and skin ulcers (construct validity). The sensitivity and specificity of the MNA according to its established cut-off points were 82 % and 63 %, respectively. Positive-predictive value was 35 % and negative-predictive value was 93 %. By using the best cut-off point (MNA score of 22 according to Youden index), the sensitivity, specificity, positive-predictive value and negative-predictive value were 88 %, 62 %, 57 % and 89 %, respectively.

Conclusions The MNA with its established cut-off points may not be a good fit for Asian populations, including Iranian elderly.

(Received July 09 2009)

(Accepted January 20 2010)

(Online publication March 01 2010)


c1 Corresponding author: Email