Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

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

Abstract

Objectives:

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.

Subjects/Methods:

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.

Results:

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.

Conclusions:

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

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

Figure 1
Figure 2

References

  • Alaimo K, Olson CM, Frongillo Jr EA, Briefel RR (2001). Food insufficiency, family income, and health in US preschool and school-aged children. Am J Public Health 91, 781–786.

    Article  CAS  Google Scholar 

  • American Diabetes Association (2000). Type 2 diabetes in children and adolescents. Diabetes Care 23, 381–389.

    Article  Google Scholar 

  • American Dietetic Association (1994). ADA's definitions for nutrition screening and nutrition assessment. J Am Diet Assoc 94, 838–839.

    Article  Google Scholar 

  • Badeyan G, Guignon N (2006). Obesity and Asthma: Two Pathologies whose Prevalence among Children is Growing, Surveyed through School Medical Examinations. Ministry of Employment and Social Affairs and Ministry of Health, Family Matters and the Handicapped: Paris, France. Available at: http://www.insee.fr/en/ffc/docs_ffc/DONSOC02g.PDF.

    Google Scholar 

  • Bangash SA, Bahna SL (2005). Pediatric food allergy update. Curr Allergy Asthma Rep 5, 437–444.

    Article  Google Scholar 

  • Birch LL, Fisher JO (2000). Mothers' child-feeding practices influence daughters' eating and weight. Am J Clin Nutr 71, 1054–1061.

    Article  CAS  Google Scholar 

  • Boutry M, Needlman R (1996). Use of diet history in the screening of iron deficiency. Pediatrics 98, 1138–1142.

    CAS  PubMed  Google Scholar 

  • Briefel R, Hanson C, Fox MK, Novak T, Ziegler P (2006). Feeding infants and toddlers study: do vitamin and mineral supplements contribute to nutrient adequacy or excess among US infants and toddlers. J Am Diet Assoc 106, S52–S65.

    CAS  PubMed  Google Scholar 

  • Briefel RR, Johnson CL (2004). Secular trends in dietary intake in the United States. Annu Rev Nutr 24, 401–431.

    Article  CAS  Google Scholar 

  • Campbell MK, Kelsey KS (1994). The PEACH survey: a nutrition-screening tool for use in early intervention programs. J Am Diet Assoc 94, 1156–1158.

    Article  CAS  Google Scholar 

  • Ells LJ, Hillier FC, Summerbell CD (2006). A Systematic Review of the Effect of Nutrition, Diet and Dietary Change on Learning, Education and Performance of Children of Relevance to UK Schools. University of Teesside, School of Health & Social Care, Center for Food, Physical Activity and Obesity Research. Available at:http://www.food.gov.uk/multimedia/pdfs/systemreview.pdf.

    Google Scholar 

  • Ervin RB, Wright JD, Kennedy-Stephenson J (1999). Use of dietary supplements in the United States 1988–94. Vital Health Stat 11 244, 1–14.

    Google Scholar 

  • Fisher JO, Birch LL (1999). Restricting access to palatable foods affects children's behavioral response, food selection and intake. Am J Clin Nutr 69, 1264–1272.

    Article  CAS  Google Scholar 

  • Freedman DS, Dietz WH, Srinivasan SR, Berenson GS (1999). The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics 103, 1175–1182.

    Article  CAS  Google Scholar 

  • Green SM, Watson R (2006). Nutritional screening and assessment tools for older adults: literature review. Issues and Innovations in Nursing Practice 54, 477–490.

    Google Scholar 

  • Health Canada (1995). Canada's Food Guide to Healthy Eating. Focus on Preschoolers. Health Canada. {H39–308/1995E} Minister of National Health and Welfare: Ottawa, ON, Canada. Available at: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/res/fg_preschoolers-prescolaire_ga_e.html.

  • Johnson SL, Birch LL (1994). Parents' and children's adiposity and eating style. Pediatrics 94, 653–661.

    CAS  Google Scholar 

  • Jones JM (2004a). Validity of nutritional screening and assessment tools. Nutrition 20, 312–317.

    Article  Google Scholar 

  • Jones JM (2004b). Reliability of nutritional screening and assessment tools. Nutrition 20, 307–311.

    Article  Google Scholar 

  • Jones JM (2004c). Development of a nutritional screening or assessment tool using a multivariate technique. Nutrition 20, 298–306.

    Article  Google Scholar 

  • Keller HH (2005). Validity and reliability of SCREEN II (seniors in the community: risk evaluation for eating and nutrition – version II). Eur J Clin Nutr 59, 1149–1157.

    Article  CAS  Google Scholar 

  • Keller HH, Brockest B, Haresign H (2006). Building capacity for nutrition screening. Nutr Today 41, 164–170.

    Article  Google Scholar 

  • Keller HH, Hedley MR, Wong Brownlee S (2000). The development of seniors in the community: risk evaluation for eating and nutrition (SCREEN). Can J Diet Prac Res 61, 67–72.

    Google Scholar 

  • Keller HH, McKenzie JD, Goy R (2001). Construct validation and test-retest reliability of SCREEN (seniors in the community: risk evaluation for eating and nutrition). J Gerontol: Medical Science 6A, M552–M558.

    Article  Google Scholar 

  • Kleinman RE (2002). Current approaches to standards of care for children: how does the pediatric community currently approach the issue? Nutr Today 37, 177–179.

    Article  Google Scholar 

  • Laporte M, Villalon L, Thibodeau J, Payette H (2001). Validity and reliability of simple nutrition screening tools adapted to the elderly population in healthcare facilities. J Nutr Health Aging 5, 292–294.

    CAS  PubMed  Google Scholar 

  • National Institute of Nutrition (2002). Iron for Health – for all Ages. National Institute of Nutrition: Ottawa, ON, Canada.

  • National Statistics Online (2006). Diet & Nutrition. Proportion of Overweight Children up. National Statistics Office: Newport, UK. Available at: http://www.statistics.gov.uk/cci/nugget_print.asp?ID=71.

  • Nicklas T, Johnson R (2004). Position of the American Dietetic Association: dietary guidance for healthy children ages 2 to 11 years. J Am Diet Assoc 104, 660–677.

    Article  Google Scholar 

  • Nicklas TA, Yang SJ, Baranowski T, Zakeri I, Berenson G (2003). Eating patterns and obesity in children. The Bogalusa Heart Study. Am J Prev Med 25, 9–16.

    Article  Google Scholar 

  • Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM (2006). Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 295, 1549–1555.

    Article  CAS  Google Scholar 

  • Padget A, Briley M (2005). Dietary intakes at child-care centers in central Texas fail to meet food guide pyramid recommendations. J Am Diet Assoc 105, 790–793.

    Article  Google Scholar 

  • Polhamus B, Dalanius K, Thompson D, Scanlon K, Borland E, Smith B et al. (2003). Pediatric Nutrition Surveillance 2001 Report. Department of Health and Human Services, Centers for Disease Control and Prevention: Atlanta, USA.

    Google Scholar 

  • Richards C, Wilkinson S (1998). Kindergarten Nutrition Screening Program, Community Health Services, Prevention. Okanagan Similkameen Health Region: Kelowna, BC, Canada.

    Google Scholar 

  • Rush D (1997). Nutrition screening in old people: its place in the coherent practice of preventive health care. Annu Rev Nutr 17, 101–125.

    Article  CAS  Google Scholar 

  • Sanderson R, Cullis H, Rysdale L, Beyers J (2001). Community-based pre-school nutrition screening: feasibility assessment. Public Health & Epidemiology Report Ontario (PHERO) 12, 82–88.

    Google Scholar 

  • Sermet-Gaudelus I, Poisson-Salomon A-S, Colomb V, Brusset M-C, Mosser F, Berrier F . et al. (2000). Simple pediatric nutritional risk score to identify children at risk of malnutrition. Am J Clin Nutr 72, 64–70.

    Article  CAS  Google Scholar 

  • Shields M (2005). Nutrition: Findings from the Canadian Community Health Survey. Measured obesity: Overweight Canadian Children and Adolescents. Statistics Canada: Ottawa, ON, Canada. Available at: http://www.statcan.ca/english/research/82-620-MIE/2005001/pdf/cobesity.pdf

    Google Scholar 

  • Statistics Canada (2001). Canadian Community Health Survey (CCHS). Questionnaire for Cycle 1.1 (September 2000–November 2001). Statistics Canada: Ottawa, ON, Canada.

  • Statistics Canada (2006). Nutrition: Findings form the Canadian Community Health Survey – 1994. Statistics Canada: Ottawa, ON, Canada. Available at: http://www.statcan.ca/english/research/82-620-MIE/2006002/tables.htm

  • Streiner DL, Norman GR (1996). Health Measurement Scales: A Practical Guide to their Development and Use. Oxford University Press: Toronto, ON, Canada.

    Google Scholar 

  • Sudbury & District Health Unit (2004a). How to Build a Healthy Preschooler. Sudbury & District Health Unit: Sudbury, ON, Canada. Available at: http://www.beststart.org/resources/nutrition/index.html.

  • Sudbury & District Health Unit (2004b). The ABC's of Feeding Preschoolers. Sudbury & District Health Unit: Sudbury, ON, Canada. Available at: http://www.beststart.org/resources/nutrition/index.html.

  • United States Department of Agriculture and Center for Nutrition Policy and Promotion (1999). Food Guide Pyramid for Young Children. United States Department of Agriculture. Available at: http://www.usda.gov/cnpp/KidsPyra/.

  • Veugelers PJ, Fitzgerald AL (2005). Prevalence of and risk factors for childhood overweight and obesity. Can Med Assoc J 173, 607–613.

    Article  Google Scholar 

  • Wardle J, Guthrie CA, Sanderson S, Rapoport L (2001). Development of the children's eating behaviour questionnaire. J Child Psychol Psychiatry 42, 963–970.

    Article  CAS  Google Scholar 

  • Whitaker RC, Orzol SM (2006). Obesity among US urban preschool children: relationships to race, ethnicity, and socioeconomic status. Arch Pediatr Adolesc Med 160, 578–584.

    Article  Google Scholar 

  • Whiting SJ (2002). Obesity is not protective for bones in childhood and adolescence. Nutr Rev 60, 27–30.

    Article  Google Scholar 

  • Whitlock EP, Williams SB, Gold R, Smith PR, Shipman SA (2005). Screening and interventions for childhood overweight: a summary of evidence for the US Preventive Services Task Force. Pediatrics 116, e125–e144.

    Article  Google Scholar 

  • Yeung H (1998). Development of a Nutrition Screening Tool to Identify Preschool-aged Children at Risk for Nutrition Problems: Determination of Nutritional Concerns of Preschool-aged Children of Southeast Vancouver. Vancouver/Richmond Health Board: Vancouver, BC, Canada.

    Google Scholar 

Download references

Acknowledgements

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.

Author information

Authors and Affiliations

Authors

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.

Appendices

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

Table

1 Dietitians of Canada, the College of Family Physicians of Canada, Community Health Nurses Association of Canada, Canadian Pediatric Society (2004). The use of growth charts for assessing and monitoring growth in Canadian infants and children. Can J Diet Prac Res 65, 22–32.

2 Ontario Society of Nutrition Professionals in Public Health (2004). Pediatric nutrition guidelines for primary health care providers. Ontario Society of Nutrition Professionals in Public Health. Available at http://www.osnpph.on.ca/pdfs/pediatric_nutrition_guidelines.pdf.

3 York Region Health Department (2004). A quick reference guide for early years professionals. Early identification in York Region. Red flags. York Region Health Department. Available at http://www.region.york.on.ca/.

4 Health Canada (1995). Canada's Food Guide to Healthy Eating Focus on preschoolers. Background for educators and communicators. Health Canada (H39-308/1995E). Available at http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/res/fg_preschoolers-prescolaire_ga_e.html.

5 University of Montreal, Nestle Nutrition, and Dietitians of Canada (2002). Healthy ABCs. Assessment from birth to childhood (0–5 years). A problem-based learning program. Resource guide for participants. Workshop materials from Integrating Nutrition into Family and Paediatric Practice Conference, Vancouver, BC.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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). https://doi.org/10.1038/sj.ejcn.1602780

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.ejcn.1602780

Keywords

  • screening
  • preschoolers
  • nutrition risk
  • validity
  • reliability

This article is cited by

Search

Quick links