Undernutrition in older outpatients is common, consequential and largely invisible, because weight is often not measured, and when it is, a stable weight in someone losing muscle and gaining fluid looks reassuring.
The short-form Mini Nutritional Assessment is six questions - appetite and intake in the past three months, weight loss, mobility, recent acute illness or psychological stress, cognitive or mood problems, and body mass index or calf circumference. It takes four minutes, needs no blood test, and produces a number that can be repeated at the next visit to show direction.
Use calf circumference where a reliable height or weight is not obtainable, which in practice covers most patients who cannot stand. And record the score, not just the category: a patient who moves from 22 to 25 has improved even if they were 'at risk' at both visits, and that is the only way anyone will notice the diet advice worked.
- Do the short-form Mini Nutritional Assessment at the first visit and repeat it at six months
- Use calf circumference when height and weight cannot be measured reliably
- Record the numerical score, not just the risk category, so change is visible
- A stable weight does not exclude undernutrition - ask about intake and appetite directly
- Check dentition, swallowing and who does the cooking before writing a dietary prescription
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