Efficacy of the Mini Nutritional Assessment to predict the risk of developing malnutrition or adverse health outcomes for old people

Background & aims: The Mini Nutritional Assessment (MNA) is a screening method, to detect the presence of malnutrition and the risk of developing malnutrition among elderly. Also an association between the MNA and adverse health outcomes (e.g. increased morbidity, mortality and discharge to nursing home) has been stated, based on follow-up studies. The purpose of this study was to assess and discuss the efficacy of the MNA to predict the risk of developing malnutrition or adverse health outcomes for old people. Methods: Follow-up studies using MNA were identified. The prevalence, sensitivity, specificity, predictive values (PPV and NPV) and the Youden Index were calculated. Results: Six follow-up studies were included. The MNA had a high sensitivity with regard to mortality. However, the specificity with regard to predict mortality was low in most studies, which means that the prevalence of "false" positives was high. The PPV was in general low. Hence, a low proportion of the elderly who screens positive is truly at risk. Supportive of this, also the Youden Index was in general low. Conclusion: The routine use of MNA among old people to screen for risk of developing malnutrition and adverse health outcomes should be carefully considered, since the risk of "over-diagnosing" is high and the consequences of a positive screening result is uncertain.