n?il 7 mJu?

il 1 3JO'S1VJ3J - l3J'H1ZJU 2554

.. .
1 nn"arfl'111,\'If:JJ '1ft.!
q
(fest-retest reHability of Thai Mini Nutritional Assessment used by Volunteers in Community Setting)
Ii'
"JntJlilHU fifi f)'i'JJtJ rI. '11. Witayaporn Sripirom MD.
jf)f1U fff11Unff}61 rI.V. Pokin Sakarinkhul MD.
milJ'Il'U!1"lfil'i'JlHhrnJ Department of Social Medicine
1HVHJ1t11 TV! 'U Lamphun Hospital
"
..... ,
lJ't1f1V1t16
I " it t
1'U! lJ{liJ ou b'1' '1tldiJfJ
tJ'J Ifl"lf'U If)l'J'UD''J Nb'1' 'I mrJ iJ1JvJD{lJ f)1'J Ifl"lf'U 1f)1'J'UD"JN b'1' "JD l(l(Mini Nutritional
(iJ'U q qJqJ q
'j/ I " t ,
'li.., d ..I " r-I <!! 'I'li') 'lir-lli] ''I ' "') 'I 'li'li
Assessment, MNA) l'I'JDlJ'Vl"J'I11fl11lJ!.'Vll'J'II'I'J "J'UfJ'IUiJiJnfJ'JlJ'UllJD\jO t"lf 1"lf1JfI{,'Iltn'VlNf)1'J!tl'l'Vll'J !I'I(I t'l1f;!
1'U 01'JtJ':l lfl"lf'U101'JNb'1' "JfJltlDlb'1'lb'1':iJfI "J HIlf)f)l'J
'U q

:V cv tV 0 Q.I t Q,I.:!t ... 1 'jJ
sampling) serum albumin 'ill'U1'U 2 m'l'l1Nf)'U 1
'tllf)1'J1!fI'J 1:;ri,j'DlJmt1ltJ 'U'illf)f)1'JY1 serum albumin 'U lj;lDf)1mUf)
'"
t I I h
d iJ f j) t d .ad,...1 0' ... t
U'il'lfl11lJtl fJlq! t! 'U1Jl1'I'J!1'U 'Vl1'lb'1'fJiJfll1lJl'VlrJ'II'I':l "J'U fJ"Jt! Ul)nD':llJ
11'l(l'l11th Cronbach's alpha Kappa coefficient
39 fI'U 12 30.8) 27 69.2) 71.8 il
. .
u
.
q
d Ij/ d d! <') d 9J .::1 Q.I ""
fIl1:;'ll'l 1 51 49 lJ'i:;l'IiJ serum albumin 'Utnlll'fl
j/ I 'j} , ,
",I f J Q,.f d t::I I Q,) d d I sv .::1
100 fll Cronbach's Alpha Coefficient 'illf)mn "J'Vl 1 lJfI1 0.50 I fI'J'lll 2 lJfI1 0.507 ttl l'Il:;'UfJ'Vl 1-3
v v ,
QI Y f(Vd..r:::1t
t110'YI'l'l1lJl'I 18 'UfJI'YI1'U 'U'VllJ fI1 Kappa Coefficient> 0.5
Abstract
Malnutrition is a common problem in older patients. Early detection of malnutrition is important in Family
Practice. The Mini-Nutritional Assessment(MNA) test had been used for nutritional assessment in many countries. The
purpose of the .study was to evaluate reliability of Thai-MNA using test-retest method. 39 older Thais were purposive
Lanna Public Health Journal 77
Vol. 7 No.1 January-April 2011
sampled and were assessed by volunteers using Thai-MNA 2 times, lmonth apart. Also, serum albumins were
collected twice. First Cronbach's Alpha Coefficient was 0.50 I and the second was 0.507. Only item 1 to 3 of 18 had
Kappa Coefficient> 0.5. We recommended Thai-MNA only for screening due to lacking of reliability evidence.
Keywords: Mini-Nutritional Assessment, Thai version, Reliability.
mnh
"
11 17
tJ:i::: A'l ff 1 ;J 1 fl:i 1 U 'Ill! fl1l if 1 :i 1 '\I tJ:i ::: 'lf1 fl:i ;;ff '181 CJ 1l!
" " .
tJ :i:::t'l ffl 'l CJ fUl. 2545 l'I U'11;;ff '181UtJ:i :::tl:Jl! ff'Uilll'l
'U'U q q
(l::; 22.1
" ,
:i::: til 'U i1ii r 8fJ(l: 1
1l! fl:i8 tylf 111 l'I if1 'lfl! 1fl1:i '181fJ
JI ,
8U1 'I fJ'ln 8'11 ii ff1l! 1lJ'U8 'I
,-lJ'lfl! t118'l'\lltlU'YIUl'l'U8'1m8ufli'1 1'U
'U '\I::;11111U'
'U
1 'If'U ffl! 1'\11
'l'Uilll'll'lfl! tllfflffUm ffllil'Hl! '!'UUl::: ll!(tlfflJ.)
Nutritional Assessment, MNA)
.1 "" 1 d,p" c:I 4 A "I
U(l:::u:i:::t:lJl!ill1::: fI'lfl!1fl1HI U(l:::t'lf8tl8
Uun1ll' 1U
. "
" , ,
H'U ff8U
: 6 A A "I.J' 'I ''I '
ctr1(test-retest method) tlJmm8'1lJ8l!tlfl
" 'U
1Jflmmm'lfl1:iHl'I'YIU
U:i:till!ill1: if1'lfl! '181fJ UU vJ81lJ
'U "
m:itJ:i:::wl!ill1: Nutritional
. . .
"I d
Assessment, MNA)
UUuvJ 61lJfl1:i Ul ::;till!Jll 1:::1fI;l! 1fl1:i 'UtH 'I mQtrttl
:u1'1f1Jfl m Ul'l'l U
",,"I "'I
1Iifll'j fl fl'tn
sectional
study design)
m
f"
t;Jl:;J'I(Purposive sampling) AU l!
9J ,d 'jJ 4
1 tl.tlJfH ;J.ml;il!
"" .
60
H(lm:'YIU hfltUl1111l! hfl
"I " Y.'I . d d "I "I '" .1 '"
rju1U'YIlJfll1: U(l::;
" ,

"
0


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I
i
.
0', '''"M "'l ,
VI 1>3 fHW'Vi l'Hl lJ lJ 1J W
..
'H 1 f1l'HHHYl 'j ff 1lJl 'HHll tnt ::::
'" 'J/

1.
Nutritional Assessment, MNA)
" " .
lVItJ VI{8
ehu I 11 U f1n ffemHIJ hi' 2 f1U 1f1!&U
Jelliffe DB. The assessment of the
" .. .
nutritional status of the community. WHO monograph
2 series no. 53, Geneva, 1996. p 77.

'" ..
Ul'HUf1
<!I
H'UU(Mid arm circumference, MAC 'HlJlmH f111lJtJl1H)
o f d 'J/ ,
W acromIOn
lIa::; olecranon 1-2)
9,1O,1!,12 Circumference, CC fie
() I d
..
d ",
"
....1
VillI fff1'IJ tl f1 llJlUtlU Gastrocnemeus('j 1J
" . "
.
d
VllJl www.bloggang.com
o I <;J 'J/
f1
., .
30 f1::;UUU) lfl"lfUlf1l'jn
4 fttl
1 fllUl1U-l Mid(upper) arm circumference I > 23.5
Jelliffe DB. The assessment of the nutritional status
2 lf1'lfUlf1l'j(Risk for

of the community. WHO monograph series no. 53,
Malnutrition) 17-23.5
.
Geneva, 1996. p 75.
3 l'J'Vi lfl"lfUlf11'J(Malnutrition)
f1::::UUU < 17
Lanna Public Health Journal 79
Vol. 7 No.1 January-April 2011
. 10,11,12'1 """ d
2. albumm
Q.I I 9J 0 Q.I 0
"
5
10
serum albumin
..
> 3.5 gm/dL
'1 d 3J
'Yl Yl fl 'If'U 1flll! fl'U tl tJ(Mildmal
.
d ...
nutrition) serum albumin 3.0-3.5 gm/dL
3
.
nutrition) serum albumin 2.1-2.9 gm/dL
'Yl Yll fl 'If'U 1 fl11:U 1 fl (Severemal
.
nutritibn) serum albumin < 2.1 gm/dL
o "" d 3J ... " 0.1" 0 I ""
1!'U'Ufll1!fl11'U 11Unm:ufll1ul
..
lfl'lf'Ulflll'Utl.:lNff.:ltlltJ(Mini Nutritional Assessment, MNA)
.. .. .
serum albumin 1'U 1'U 2
SPSS(Statistical Package for
Social Sciences)
,"
"" " 3J .;, Il] 0 I 0
1.
..
:UWll!l'U
2. 'Yl fftl11 fl11lH tJ.:I 'Utl.:lU1111 l'ltl{:u fll1U dJ'U
I 6
alpha Kappa coefficient
o Q.I I Q.I ..::::t 3J 'l!
"
'Ul'H'Ufl m'Ultl111.:1U'U'U m'Ultl111.:1
tl tl.:l U U'U 'U fl 11 U dJ'U lfl 'If'U 1fl 11'U tl.:l
Nff tl I N
'U cu .. u
Q.I d. Q.I I d.Q.I 0 Q.I
Serum Albumin
p < 0.005
iJ 1.:1'Jl(No Clinically. significance)
I . .d I d ,
Wi! tJ'Utl.:l'Yl .:Ifftl.:l 3.5 mg/dL
d
1)
"
" I 'j/ I
f11'iHfi 1 1 2
.... .
Difference(possibility)
.. I
Vd
flHfll
o 3J ...
1I1'U1'U!'Iff .:ItlltJtl1 ff1ff:U m(fl'U) 39(100) . 39(100) o
.. .. .
o
1. 'lf1tJ 12(30.8) 12(30.8)
2. m,lJ.:I 27(69.2) 27(69.2)
u
mtJ(iI) 71. 77(8.39) 71. 77(8.39)
o .
.
n7l1 7 tlUU7l11 3JO'S11N3J - 2554
f 'j/ 'jI , 'j/ I
Al'H3n 1
v .!l !II 0
1l6lJllYil!!11.1 ml!lU(
.
., .
.., .ot .., .ot
"
f11-3f1 1 f1Hf12
iI
1.hWUtl(kg)

(Mid ann circumference, MAC)(cm)
I

)CalfCircumference, CCcm)
Serum Albumin(gmJdL)
'U tllnh 1.tl"lfl! N'ff 61tJ
.. '" .
(MNA Score)
48.18(10.53) 48.87( 10.19)
152.67(9.07) 152.51(9.20)
20.57(3.65) 20.92(3.53)
24.92(6.53) 26.08(8.70)
28.69(5.48) 30.23(4.85)
4.11(0.25) 4.22(0.24)
16.32(3.04) 16.15(2.31)
Difference(possibility)
-0.69(p 0.298)
0.16(p =0.543)
-0.35(p = 0.230)
-1.l6(p 0.480)
-1.54(p = 0.139)
-O.ll(p 0.002*)
0.17(p = 0.737)
* p < 0.005
" "
11 1 tl tlU 1l ';j ::: t iJ 'U .tl11 1 fl "If l! 1 tlU N' ff 61 tJ 0.152)
'" '" .
tJ 1ff1ff:UfI"J WU11trltJ '1 <Nu u u 'ti tJ1lJ tll';j 1l ';j::; til'U .tln::: . Serum albumin fHluwuh
"i 'JJ 1II!iI'jI .,I",
1.tl"lf'U
ifl"lf'U ifl"lf'U1tllnh
, .
" .
"
50 ..
.,; 1 'jI A.I "" 'jI .1" .1 ""

1 'JJ
m11UI 2 f111::: .tl"lf'U1tllHJff mm1JtJ 1J 'j :::tlJ'U ';jlJ tll';j 1J fl"lf'U ltll';j'IJ flff tJla(Mini
.:u (\ cu <u q
.1 '" ..,
Nutritional Assessment, MNA) Serum albumin
.. . .. .
..,.ot
flHf11 2 'tUJ1ft't'ltiJ
0 0
mU1U "11.111.1
tumll::;) " "
11UU WtJ 11J tl1"J 1l';j :::til'Ufl11::; 0(0) 0(0) p = 0.152
2 ifl"lf'U1tll'J 19(48.7) 21(53.8)
(Mini Nutritional Assess ment, (Risk for Malnutrition)
MNA) 3 lfl"lf'U1tll';j 20(51.3) 18(46.2)
(Malnutrition)
Lanna Public Health Journal
81 Vol. 7 No.1 January-April 2011
Nutritional Assessment, MNA) Serum
.. . .
v,", "
fl'HfI 1 fl1-3fl 2
Q Q
<llllnU <llllnU
1II 1II

39(100) 39(100)
0(0) 0(0) ffUJljtl Serum albumin
(Mild malnutrition) Ih::::liJUp
3 'fl'Vli.fl<JfUlf)1nhuflt'l1.:J 0(0) 0(0)
.
(Moderate malnutrition)
4 'fl'Vli.fl<JfUlf)11lJlfl 0(0) 0(0)

(Severe malnutrition)
* No statistics are computed because both variables are constant. '"
>I
Coefficient 'VlUilfllj'llnliJufl1.:Jlll lJril Cronbach's
" .
III ,
Alpha Coefficient = 0.501 ut'!::::fllnh::::!iJufl1.:JVj 2 lJril
'lit) fll Kappa Approximated Significance(p)
..
.
di: .. I'd ..i
Cronbach's Alpha Coefficient = 0.507 9f.:J UlJt't1UJfl11:JJ
fI Coefficient
'" 13 ''I ' '" ""6 I
tU (Internal Consistency) oy U\'l
5
1.ff'U1JuvJo1:JJfllnh::::!iJufll1:::: i.fl<JfUlfllj'UO.:J
6
. " .
" I d d Ij/ d I 41 .::::!d. Q,J
Nff.:jOllJ'VlU11:JJt'VllJ.:j'UO'fl 1-3 !'fllUU'flllfl111lUUUUlJ
"'II
7
'" "" 6 ""
fll{J IUOY Kappa Coefficient> 0.5)
8
4, 9, 16 Kappa
9
Coefficient 3)
10
. ,
'"'. "" .1 '" .1 "'"
VlT:iHfl3
11

'II .. 12
1II f
'lit) fll Kappa Approximated Significance(p)
13
.
fI '"' Coefficient
14
0.725 0.000*
15
2 0.638 0.000*
16
3 0.541 0.000*
17
4 1JJ **
18
0.260 0.102
-0.026 0.861
-0.083 0.536
-0.043 0.732
1JJffllJl'itl'll j::::!iiU1 **
-0.106 00489
-0.026 0.869
0.066 0.526
0.l26 00429
-0.129 00418
-0.073 0.509
***
-0.040 0.770
'JJffllll 1 tl'll
Q'
fll'U1tu'l11fll Kappa
,
:v
fl'U V 1'l11'j W'l
82
..
* p &-0.005
<J
** Kappa statistics cannot be computed. They require a symmetric 2-way table in which the values of the first variable
match the values of the second 4)
*** No statistics are computed because one variable is a 4)
. . .
4, '9 11(;1:;: 18(lPIllHli 4) 'W'Irh
1" I tjJ Q.t " d
Coefficient \PI ff1'U'lH) 16 'U'UlJ
'" 1j1 tjJ c9
"
II 0 Q,J'
\PI V'U 'tI H mulf1!flVU'VI'l'l11J'fl1l'l
'thlW'l:UffllJllUtll'U1tufll Kappa Coefficient
. " .
ilV ";hfllli I ffV 'llnVUIrl'Ufllfl'lll
... . ., .
v.c( v V Q
'lIVflU1UJ flHfll flHfl2
Q V Q v

;i
.4111'l1UflVli11'U'lf1'l 3 Mm'l > 3 flfl. 2(5.1) 0(0)
1:U'VInu 6(15.4) 0(0)
2(5.1) 1(2,6)
..
29(74.4) 38(97.4)
\
1(4,.6) 0(0)
"" " 32(82.1) 1J m fl1l 'l1 "'IU1'I 24(615)
1:uii iJtlJ 'l11 14(35.9) 7(17,9)
"d '_!II
16. fl1lfl'Um'Hll \PIV'llJfl'U"If1fJ1JV'U 0(0) 0(0)
39(100) 38(97.4)
fl'Um'l1l'HV'l 0(0) 1(2.6)
3(7.7) 2(5.1)
27(69.2) 0(0)
2(5.1) 32(82,1)
7(17.9) 5(12.8)
cl
!!"INUHfl11
" ",

1l1fl'li'V1J "1'U

'tI V'I fl 10V1'1'til (IU ,Vi (IU tI':i:::llJ lil"lf'U lfl1'j 'tit) VV1'l i:u
..
"
.
tJ " )l
, w Q,I 4 f 0 Q,I' C! QI
1 2 'YfIJ11'U 1'l1'Ufl ff1'Utl'l \PI"If'U
<J ' ..
Lanna Public Health Journal 83
Vol. 7 No.1 January-April 2011
y v
lh:aiJu rilml:l1U N \I i:i
v ,
d , (11 d..:::t ., d
l'VW\I serum albumin 11'11'W'W1'111fll111UlItl1l1'l6tJ1\111
..
albumin 21 1'W 14
v ,
llJunm serum albumin lufli'\ln 2 i:i
1'Wfli'
v
\111 1 tl
..
1\111,ml:ll1'W1:Ji:i Um:ilflty1'l1\1flilu I
trl 6Yl 1l1'J'WlUiJ iJ-n611J Ifl'lf'Wlfll1
'jI I I
Cronbach's Alpha Coefficient
11 t 11 I
1h::liJ'Wfli' \In 1 'Wfli' \In 2 i:i Cronbach's
Alpha Coefficient
.... I 9J 1'JJ.d
I1JflU11Jl'l11 fl1 Kappa Coefficient ntJ'lJfl
\I
"
w 'jI'I 'jI'jI 'jI '" &
fllff1ff1Jm)
'U 'U qJ 'U q
'v
o 'I 'jI "" 'jI , "I 'jI15 I 'jI do'"
1'l1 l'lfU'lJ61'14. 'W1'I1Ufl
3 4)
v
> 3 flfl. 1,j1'1'J'lU 1 3 flfl. 6d
v tJ 1
10 25.6) 11.1 fli'\lflI 2 mlui:i
v
9J 0' Q.I e!i' d gJ
1 tl\l 3 flfl. 1i1t1\1 1 2.6)
"
II I I' Y
1111UUrUfl\l1JHlfl
D1ff1,r'WW\I
m 1tJ\l1UI 'W l1'1f1'i1u";huuU-n6{1Jfl1'J'
"" 1 'jI d .d 'jI
tI fI'lfU F.;l\1' H I'IJ 1
n U fl U tI 'J':::: til 'W 1fI'If'W 1ti 11 1 tJ I l1U serum
34
albumin U 1fl fll 'J' ri' 'W '111 fll1 l'J i11 fl 'If 'W 1 fln 1 tJ
Of Of
lt1JU-n6{1JU Serum albumin 11.1
I 'jI w
tl q1J fj \1' \I 61 61 ff 1 tl a U i1U fll11J 'l1 tl 'II 6 \I fill l'J i1
lf1 'If'W 1fll'J' I 'W 1J1Oi16th\I 50
11 v f Y
11\1 U1'u6\1 UU-n til'W lf1'1f'W ltlUU
ff llll'J' tl ri''W i1U fll11J1 lfll m iJU
I fl 1 fll'J' i
serum albumin
tI tlW \li:ifl111J m ff1J tljpJlJ iJ fl \I fll 'J'
116 \In'W n6Utlj1JlJiJ(Primordial Prevention)
. . .
9,J 91d.c::::! d t G) .c:t u.< d 1
fl fI'If'W lfll1 t'W'lJW::::1'1tJ\l1J
fll1111 tJ \I \1' \I 11 t:l U\ll,j i:i 61 tl n '11 fl D 1 tl n 11 \l1'1N
, . "
flitUfl
11 iJ iJ -n 6 {ll fln tl1:::: I:lJU 1 fl'lf'W 1 fll1'IJ fl \I
\lfl1(1(Mini Nutritional Assessment, MNA) ffllll'J'tl
" " .
l,jl'If'4flmm1'11\1fll'J'H'Vf1'1v1 'Wflnri'U'I11
Prevention)
\
Ullll Ufll'J'lumltJill1::::l'J'Vf lfl'lf'Wlfll1

fl11i:i flU ri''W \I(Reliability) 1
l1i fll'J' g'W 1 '111 fl! 1411 1'W 1 'W 16VHI
i 1(Sensitivity) Hi:!:i:fl111J 1!'Vf 1::::
(Specificity) 'lJ6--3UiJiJ-n611JflUtl'J'::::liJ'Wfll1:::: lfl'1f'W1fll'J'
Nutritional Assessment, MNA) 1'W
".. ""
tI'J':::'lflfl'i\1'

'lJ6'IJ6Ui1'J':;fJtufJtulflff1
'" ., 'jItI "" ., 'jI
lH)\lfltul1flfJ
q
v
f} 1fflffirmfliJ tY1'Wl1 1ill'\l1'W
d' a-d' 3J
""
8. U'JVi'W'YI'J 'Ul'Jll\l, lllm 1l1ty'JflfJ, 'V'lffllV
l. ,,!'lIflWffl'W1YIfJ lfffll '611

d. 'JI
2550. 'Wmtlifll: ff 2548; 28(2): 77-90 .

P 86-121. 9. Lee RD, Neiman DC. Anthropometry. In: Lee RD,
2. \I fllfJ UM Neiman DC, editors. Nutritional Assessment. Dubuque:
<u ...
"'... .. cJ !II !II .. '"
W11'll''W !Ufllff fl'W'V'lfll'J
..
9J Q.I Q.I c:,
m 1ff
..
'lIU\l1JlffHJ; 2547. p 7-24.
3. Guigoz Y, Lauque S, Vellas BI. Identifying the
elder at risk for malnutrition. The Mini Nutritional
It,;
Assessment. Cli Geriatr Med. 2002 Nov; 18(4): 737
57.
4. Vellas B, Guigoz Y, Garry PI, Nourhashemi F,
Bennaham D, Lauque S, Albarede IL. The Mini
Nutritional Assessment(MNA) and its use in grading
the nutritional state of elderly patients. Nutrtion.
1999 Feb; 15(2): 116-22.
5. Guigoz Y. The Mini Nutritional Assessment(MNA)
review of the literature What dose it tell us? J Nutr
Health Aging. 2006 Nov-Dec; 10(6): 466-85;
discussion 485-7.
6. Ann Bowling. Techniques of questionnaire design.
In: Ann Bowling, Shah Ebrahim, editors. Handbook
of health research methods. Investigation,
measurement and analysis. Glasgow: Open
University Press; 2005. p. 394-403.
Q,I Q,lQ'J,I .
7. VUl'. 2546, 3, 1l'Jfl
1(2546).
Wm. C. Publishers. 1993: 170.
10. Ielliffe DB. The assessment of the nutritional status
of the community. WHO monograph series no. 53,
Geneva, 1996.
11. WHO Expert Committee on Medical Assessment of
Nutritional Status. WHO Technical Report Series
no.258, Geneva, 1993.
12. rtim.nJty. ifl'll''Wlfl1'J
(Assessment of Nutritional Status). 1u
'U'JHil11iflll.
2540. P 1()-48.
13.
.t,) , q cu
[cited 2010 Feb 17]. Available from: URL:
http://service.nso.go. th/nso/g_knowledge/estat/esta 1
Il.html.
14. Peralta R. Hypoalbuminemia. E-Medicine [cited
2007 17 Feb 10]. Available from: URL:
http://emedicine.medscape.com/article/ 166724
overview.
15. flffi'{J! fl1l1.ij(J'YIHfll'Jfffl1n(Educational
Research).
""'" "'l
FE51l fll'J11lV'YI1\1fll'JffflfJ1(Educational Research).
Q ;t!fi dl rI
fll W)'lfl fll 'U Hl1'J fll'J fffl fJ 1 fl W fff1fJ 'J
Q.! Q.I .c::).
111111'Y1(J1 l (J'YIf1fJ W(25 52).