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Nutrition Screening Tool for Every Preschooler (NutriSTEP™): validation and test–retest reliability of a parent-administered questionnaire assessing nutrition risk of preschoolers



Study 1: To establish the validity of scores on Nutrition Screening Tool for Every Preschooler (NutriSTEP), a community-based parent-administered screening tool for assessing nutrition risk, by comparing scores to an expert rating. Study 2: To demonstrate test–retest reliability of NutriSTEP.


Study 1: Parents of 269 preschoolers (of 294 parents recruited from the community), completed the NutriSTEP questionnaire; a registered dietitian (RD) assessed the nutritional status (based on medical and nutritional history, 3 days of dietary recall and anthropometric measurements) of these preschoolers and rated their nutritional risk (1 (low) to 10 (high risk)). Receiver operating characteristic (ROC) curves were used to establish validity and determine appropriate cut points based on sensitivity and specificity. Study 2: Parents of 140 preschoolers (of 161 recruited) completed NutriSTEP on two occasions. Intraclass correlation (ICC) and κ were used to assess reliability.


Study 1: Scores on NutriSTEP and the RD rating were correlated (r=0.48, P=0.01). Area under the ROC curve for the high risk RD rating (score 8+) and the moderate risk rating (score 5+) were 81.5 and 73.8%, respectively. A moderate risk cut point of >20 and high risk cut point of >25 were identified for the NutriSTEP scores. Study 2: The NutriSTEP score was reliable between administrations (ICC=0.89, F=16.7, P<0.001). Most items on the questionnaire had adequate (κ>0.5) or excellent (κ>0.75) agreement.


The NutriSTEP questionnaire is both valid and reliable for determining nutritional risk in preschoolers.

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This work was supported by the Canadian Institutes of Health Research (Institute of Population and Public Health and Institute of Nutrition, Metabolism and Diabetes), the Provincial (Ontario) Public Health Research, Education and Development (PHRED) Program, the City of Greater Sudbury Ontario Early Years Challenge Fund and Health Canada (Population Health Fund). We especially thank the parents and the preschoolers who participated in this study. We thank Sandra Juutilainen, Lorianne Maclean and Suzanne Lamoureux as validation Registered Dietitians for this project. We acknowledge the support with recruitment of participants from the following: Mary Turfryer from the York Region Health Unit, Nancy Summers from the Middlesex London Health Unit, Sharon Dinsmore from the Grey-Bruce Health Unit, Elizabeth Shaver Heeney from Hamilton Public Health and Community Services, Pat Hanly from the Perth District Health Unit and Joy Walker from the Guelph Community Health Center. We thank the following students for their role in data collection for the test–retest reliability: Amanda Degen, Jill Stroud and Kathleen Hennessy-Priest. For data entry and management, we thank Jill Stroud, Kathleen Hennessy-Priest and Alissa Palangio. We are grateful to Richard Goy for statistical analysis.

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Authors and Affiliations


Corresponding author

Correspondence to J A Randall Simpson.

Additional information

Guarantor: JA Randall Simpson.

Contributors: JARS, HHK, LAR and JEB planned and designed the study and obtained funding. LAR managed and coordinated the project. JARS coordinated data collection for some of the test–retest reliability. HHK was responsible for data analysis. All authors contributed to the writing and revision of the paper.


Appendix A

Item stems from NutriSTEP questionnaire

  1. 1

    My child usually eats grain products:

  2. 2

    My child usually has milk products:

  3. 3

    My child usually eats fruit:

  4. 4

    My child usually eats vegetables:

  5. 5

    My child usually eats meat, fish, poultry or alternatives:

  6. 6

    My child usually eats ‘fast food’:

  7. 7

    I have difficulty buying food to feed my child because food is expensive:

  8. 8

    My child has problems chewing, swallowing, gagging or choking when eating:

  9. 9

    My child is not hungry at mealtimes because he/she drinks all day:

  10. 10

    My child usually eats: (number of times per day)

  11. 11

    I let my child decide how much to eat:

  12. 12

    My child eats meals while watching TV:

  13. 13

    My child usually takes supplements:

  14. 14

    My child: (gets enough/needs more physical activity)

  15. 15

    My child usually watches TV, uses the computer, and plays video games:

  16. 16

    I am comfortable with how my child is growing:

  17. 17

    My child: (weighs too little/much)

Each question has a minimum score of 0 (no risk) to 4 (risk) with the potential of two to five frequency response options. The question responses are summed to provide an index where an increased score indicates increased nutrition risk; the maximum score is 68.

Appendix B

Abbreviated standardized criteria for nutritional risk rating used for NutriSTEP validation


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Randall Simpson, J., Keller, H., Rysdale, L. et al. Nutrition Screening Tool for Every Preschooler (NutriSTEP™): validation and test–retest reliability of a parent-administered questionnaire assessing nutrition risk of preschoolers. Eur J Clin Nutr 62, 770–780 (2008).

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  • screening
  • preschoolers
  • nutrition risk
  • validity
  • reliability

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