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UWL: Screening and Assessment Methods (2009)

Study Design:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:

To determine the nutritional status of the elderly using two different instruments, the Mini Nutritional Assessment (MNA) and Nutritional Screening Initiative Checklist (NSIC) and evaluate consistency of the methods.

Inclusion Criteria:

Elderly volunteers

Exclusion Criteria:

None specifically mentioned

Description of Study Protocol:


Recruitment methods not described


Cross-Sectional Study 

Statistical Analysis

  • Cumulative scores were calculated for both checklists
  • Based on pre-set cutoff values, subjects were classified in nutritional risk categories according to either score
  • Kolmogorov-Smirnov test was used to determine whether outcome variables were normally distributed, and the differences were assessed using Mann-Whitney U test
  • Spearman rank correlations were used to assess the associations between the two assessment methods and for other variables
  • Agreement between MNA and NSIC points were analyzed by Kappa statistical method.
Data Collection Summary:

Timing of Measurements

Study carried out between February 2003 and March 2004

Dependent Variables

Nutritional status

Independent Variables

  • Mini Nutritional Assessment (MNA): 18 items, including anthropometric measurements (body weight, height and weight loss), global assessment (six questions related to lifestyle, medication and mobility), a dietary questionnaire (eight questions related to the number of meals, food and fluid intake), and subjective assessment (self-perception of health and nutrition).
  • Nutritional Screening Initiative Checklist (NSIC): 10 yes or no items that are given different weights associated with the nutritional well-being of older people. 


Description of Actual Data Sample:


1,564 elderly volunteers, 689 males, 875 females


Median age of 70±8 years

Ethnicity: Not described

Other relevant demographics:

  • 49.4% were married
  • 65.3% were living with their families
  • 32.3% had only a primary school education.


Ankara, Turkey

Summary of Results:

 Age and Anthropometric Measurement of the Elderly According to MNA and NSIC Classification


malnourished (n=1,311)

Well nourished (n=253)
NSIC  High risk (n=559) NSIC - Moderate/good (n=1,005)

Median age (years)

70 70, P=0.118 71 70, P=0.110
Median body 67 75, P=0.000 66 70, P=0.120
Median height (cm) 160 165, P=0.000 161 162, P=0.481
Median BMI 25.9 27.1, P=0.000 25.5 26.3, P=0.228
Median mid-upper-arm circumference (cm) 29 31, P=0.000 29 29.5, P=0.025
Median calf circumference (cm) 34.5 37, P=0.000 32.5 35, P=0.001

Other Findings

  • Body weight (P=0.000) and height (P=0.000) were higher in men than women, while BMI (P=0.000), mid-upper-arm circumference (P=0.104) and calf circumference (P=0.031) were higher in women than men
  • The prevalence of overweight and obesity was 46.9% and 10.9% in males and 47.3% and 22.5% in females, respectively
  • The MNA results (less than 17 points) indicated that 6.5% of the male and 8.8% of the female participants had inadequate nutrition
  • According to the NSIC, 34.3% of males and 36.9% of females were classified as having a high risk of nutritional deficiency
  • There was an observed decrease in MNA and an increase in NSIC scores with the increase of age (P<0.01)
  • There was a negative correlation of MNA and positive correlation of NSIC with body weight, BMI, mid-upper-arm circumference and calf circumference (P<0.01)
  • There were no statistically significant correlations between MNA and NSIC scores (r= -0.318, P>0.05)
  • Agreements between MNA and NSIC scores were analyzed and neither of these two methods can be used in place of the other (P=0.285).  
Author Conclusion:

In conclusion, we can use both the MNA and NSIC methods in the elderly, depending on the facilities and preferences to assessment and evaluation of the nutritional status. However, we cannot replace one method with the other. Since MNA includes both anthropometric measurements and other important variables, it should be considered as the most reliable and valid method.

Funding Source:
University/Hospital: Hacettepe University, Samanparazari, Ankara, Turkey
Reviewer Comments:

Recruitment methods and inclusion and exclusion criteria not described.

Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? ???
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? No
  2.2. Were criteria applied equally to all study groups? N/A
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? ???
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? Yes
  4.1. Were follow-up methods described and the same for all groups? Yes
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) Yes
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? Yes
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? N/A
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? N/A
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? N/A
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? N/A
  7.7. Were the measurements conducted consistently across groups? N/A
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? Yes
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? ???
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? No
10. Is bias due to study's funding or sponsorship unlikely? Yes
  10.1. Were sources of funding and investigators' affiliations described? Yes
  10.2. Was the study free from apparent conflict of interest? Yes