CDE Detailed Report

Disease: content
Sub-Domain: Other Non-Motor
CRF: welcome

Displaying 1 - 25 of 25
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (Question Text) Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C10063 Mini Nutritional Assessment (MNA) - assessment score MNAAssmntScore The total score for the questions after the screening score as part of MNA form The total score for the questions after the screening score as part of MNA form Aassessment total Numeric Values

Add scores for QG through QR (assessment section). Enter numeric valueof 0.0-16.0 for assessment score.. The maximum assessment score is 16 points.

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Free-Form Entry

0 14
C10042 Mini Nutritional Assessment (MNA) - weight loss 3 month score MNAWghtLoss3MnthScore The score for the degree of weight loss during the last 3 months by the participant as part of MNA form. The score for the degree of weight loss during the last 3 months by the participant as part of MNA form. Weight loss during the last 3 months 0;1;2;3 Weight loss greater than 3 kg (6.6 lbs);Does not know;Weight loss between 1 and 3 kgs (2.2 and 6.6 lbs);No weight loss Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10053 Mini Nutritional Assessment (MNA) - legume intake daily indicator MNALegmIntkDailyInd Whether the participant consumes two or more servings of legumes or eggs per week as part of MNA form. Whether the participant consumes two or more servings of legumes or eggs per week as part of MNA form. Selected consumption markers for protein intake: Two or more servings of legumes or eggs per week? No;Yes No;Yes Alphanumeric

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10064 Mini Nutritional Assessment (MNA) - total assessment score MNATotlAssmntScore The total assessment score which includes the screening score and the assessment score as part of MNA form. The total assessment score which includes the screening score and the assessment score as part of MNA form. Total assessment Numeric Values

Add the sum of the Assessment Total and Screening Total. Enter numeric valueof 0.0-30.0 for total score.

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Free-Form Entry

0 30
C10043 Mini Nutritional Assessment (MNA) - mobility score MNAMobiltyScore The score for the participant's mobile abilities in a bed or chair as part of MNA form The score for the participant's mobile abilities in a bed or chair as part of MNA form Mobility 0;1;2 Bed or chair bound;Able to get out of bed/chair but does not go out;Goes out Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10054 Mini Nutritional Assessment (MNA) - meat fish poultry intake daily indicator MNAMtFshPltryIntkDailyInd Whether the participant consumes meat, fish or poultry every day as part of MNA form. Whether the participant consumes meat, fish or poultry every day as part of MNA form. Selected consumption markers for protein intake: Meat, fish or poultry every day? No;Yes No;Yes Alphanumeric

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10065 Mini Nutritional Assessment (MNA) - malnourished score MNAMalnutrnIndScore The score indicating whether the participant is malnourished based on his or her total assessment score as part of MNA form. The score indicating whether the participant is malnourished based on his or her total assessment score as part of MNA form. Malnutrition indicator score 24-30 points;17-23.5 points;Less than 17 points normal nutritional status;at risk of malnutrition;malnourished Alphanumeric

No instructions available

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10044 Mini Nutritional Assessment (MNA) - psychological stress acute disease 3 month indicator MNAPsygclStrssAcuteDis3MnthInd Whether the participant has suffered psychological stress or acute disease in the past 3 months as part of MNA form Whether the participant has suffered psychological stress or acute disease in the past 3 months as part of MNA form Has suffered psychological stress or acute disease in the past 3 months? 0;2 Yes;No Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10055 Mini Nutritional Assessment (MNA) - select protein consumption marker intake score MNASlctPrtnCnsmptnMrkrIntkScr Sum of "Yes" answers from questions K1 - K3 as part of MNA form. Sum of "Yes" answers from questions K1 - K3 as part of MNA form. Sum of "Yes" answers from questions K1 - K3 0;0.5;1 if 0 or 1 yes;if 2 yes;if 3 yes Numeric Values

Record the sum of the number of "Yes" responses for QK1 through QK3

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10045 Mini Nutritional Assessment (MNA) - neuropsychological problem score MNANeuropsychPrblmScore The score for the degree of neuropsychological problems the participant faces as part of MNA form The score for the degree of neuropsychological problems the participant faces. Neuropsychological problems 0;1;2 Severe dementia or depression;Mild dementia;No psychological problems Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10056 Mini Nutritional Assessment (MNA) - fruit vegetable intake daily indicator MNAFruitVegIntkDailyInd Whether the participant consumers two or more servings of fruit or vegetables per day as part of MNA form Whether the participant consumers two or more servings of fruit or vegetables per day as part of MNA form Consumes two or more servings of fruit or vegetables per day? 0;1 No;Yes Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10046 Mini Nutritional Assessment (MNA) - body mass index (BMI) score MNABMIScore Body Mass Index (BMI) (weight in kg) / (height in m2) as part of MNA form Body Mass Index (BMI) (weight in kg) / (height in m2) Body Mass Index (BMI) (weight in kg) / (height in m2) 0;1;2;3 BMI less than 19;BMI 19 to less than 21;BMI 21 to less than 23;BMI 23 or greater Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10057 Mini Nutritional Assessment (MNA) - fluid intake daily score MNAFluidIntkDailyScore The score for how much fluid the participant consumes per day. The score for how much fluid the participant consumes per day. How much fluid (water, juice, coffee, tea, milk...) is consumed per day? 0;0.5;1 less than 3 cups;3 to 5 cups;more than 5 cups Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10047 Mini Nutritional Assessment (MNA) - screening score MNAScrnScore Screening score for MNA by adding up the scores for the previous questions as part of MNA form. Screening score for MNA by adding up the scores for the previous questions as part of MNA form. Screening score for MNA Numeric values

Add scores for QA through QF (screening section). The maximum screening score is 14 points. 12-14 points: Normal nutritional status. 8-11 points: At risk of malnutrition. 0-7 points: Malnourished.

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Free-Form Entry

0 14
C10058 Mini Nutritional Assessment (MNA) - made feed score MNAMdeFeedScore The score for how the participant eats his or her meals as part of MNA form. The score for how the participant eats his or her meals as part of MNA form. Mode of feeding 0;1;2 unable to eat without assistance;self-fed with some difficulty;self-fed without any problem Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10048 Mini Nutritional Assessment (MNA) - live independent indicator MNALiveIndpndntInd Whether the participant lives independently (not in nursing home or hospital) as part of MNA form. Whether the participant lives independently (not in nursing home or hospital) as part of MNA form. Lives independently (not in nursing home or hospital) 0;1 No;Yes Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10059 Mini Nutritional Assessment (MNA) - self view nutrition stat score MNASlfViewNutritnlStatScore The score for the participant's self view of his or her own nutritional status as part of MNA form The score for the participant's self view of his or her own nutritional status as part of MNA form Self view of nutritional status 0;1;2 views self as being malnourished;is uncertain of nutritional state;views self as having no nutritional problem Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10049 Mini Nutritional Assessment (MNA) - 3 prescription drug day indicator MNA3PrescrptnDrugDayInd Whether the participant takes three or more prescription drugs per day as part of MNA form Whether the participant takes three or more prescription drugs per day as part of MNA form Takes more than 3 prescription drugs per day 0;1 Yes;No Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10060 Mini Nutritional Assessment (MNA) - relative health status score MNAReltvHlthStatScore The score for the participant's view of his or her own health relative to other people of the same age. The score for the participant's view of his or her own health relative to other people of the same age. In comparison with other people of the same age, how does the patient consider his / her health status? 0;0.5;1;2 not as good;does not know;as good;better Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10050 Mini Nutritional Assessment (MNA) - pressure sore ulcer indicator MNAPrssrSreUlcrInd Whether the participant has any pressure sores or skin ulcers as part of MNA form Whether the participant has any pressure sores or skin ulcers as part of MNA form Pressure sores or skin ulcers 0;1 Yes;No Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10061 Mini Nutritional Assessment (MNA) - midarm circumference score MNAMidarmCircmfrnceScore The score of the participant's mid-arm circumference in centimeters as part of MNA form. The score of the participant's mid-arm circumference in centimeters as part of MNA form. Mid-arm circumference (MAC) in cm 0;0.5;1 MAC less than 21;MAC 21 to 22;MAC 22 or greater Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10051 Mini Nutritional Assessment (MNA) - full meal eat daily score MNAFullMealEatDailyScore The score for how many full meals the participant eats daily as part of MNA form. The score for how many full meals the participant eats daily as part of MNA form. How many full meals does the patient eat daily? 0;1;2 1 meal;2 meals;3 meals Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10062 Mini Nutritional Assessment (MNA) - calf circumference score MNACalfCircmfrnceScore The score of the participant's mid-arm circumference in centimeters as part of MNA form The score of the participant's mid-arm circumference in centimeters as part of MNA form Calf circumference (CC) in cm 0;1 CC less than 31;CC 31 or greater Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10041 Mini Nutritional Assessment (MNA) - food intake decline score MNAFoodIntkDeclnScore The score for the degree of declining food intake over the past 3 months due to a loss of appetite, digestive problems, chewing or swallowing difficulties as part of MNA form. The score for the degree of declining food intake over the past 3 months due to a loss of appetite, digestive problems, chewing or swallowing difficulties as part of MNA form. Has food intake declined over the past 3 months due to loss of appetite, digestive problems, chewing or swallowing difficulties? 0;1;2 Severe decrease in food intake;Moderate decrease in food intake;no decrease in food Numeric Values

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

C10052 Mini Nutritional Assessment (MNA) - dairy product intake daily indicator MNADairyProdctIntkDailyInd Whether the participant consumes at least one serving of dairy products (milk, cheese, yoghurt) per day as part of MNA form Whether the participant consumes at least one serving of dairy products (milk, cheese, yoghurt) per day as part of MNA form Selected consumption markers for protein intake: At least one serving of dairy products (milk, cheese, yoghurt) per day? No;Yes No;Yes Alphanumeric

Complete the screen by filling in the boxes with the appropriate numbers

Vellas B, Villars H, Abellan G, et al. Overview of the MNA® - Its History and Challenges. J Nutr Health Aging 2006;10:456-465. Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for Undernutrition in Geriatric Practice: Developing the Short-Form Mini Nutritional Assessment (MNA-SF). J. Geront 2001;56A: M366-377. Guigoz Y. The Mini-Nutritional Assessment (MNA®) Review of the Literature - What does it tell us? J Nutr Health Aging 2006; 10:466-487. ® SociÉtÉ des Produits NestlÉ, S.A., Vevey, Switzerland, Trademark Owners © NestlÉ, 1994, Revision 2009. N67200 12/99 10M For more information: www.mna-elderly.com An extensive list of references is available on the website: http://www.mna-elderly.com/recent_mna_literature.php. Adult Supplemental 3.00 2013-07-22 09:34:41.527 Mini Nutritional Assessment (MNA) Other Non-Motor Outcomes and End Points

Single Pre-Defined Value Selected

CSV