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SCREEN III: working towards a condensed screening tool to detect nutrition risk in community-dwelling older adults using CLSA data

European Journal of Clinical Nutrition (2019) | Download Citation



Screening for nutrition risk in community-dwelling older adults increases the likelihood of early intervention to improve nutritional status, with short screening tools preferred. SCREEN-II-AB is a valid 8-item tool. The current study determines whether SCREEN-III, a proposed 3-item version, adequately classifies nutrition risk in comparison.


Baseline data from the Canadian Longitudinal Study on Aging were used. Seventy-two percent (n = 24,456) of eligible participants (>55 years, complete SCREEN-II-AB) were included. Sensitivity and specificity of various SCREEN-III values compared with SCREEN-II-AB risk determined a nutrition risk cut-point and the proportion misclassified (False[−]) was calculated. Construct validity was tested against a composite variable summarizing outcomes associated with nutrition risk (e.g., self-reported health, hospitalization) using logistic regression adjusted for individual factors (e.g., marital status).


A SCREEN-III cut-point of <22 performed best on sensitivity (0.83 [95% CI = 0.82, 0.84]) and specificity (0.73 [95% CI = 0.72, 0.74]) compared to SCREEN-II-AB (Cramer’s V = 0.53). Of those at-risk using SCREEN-II-AB, 16.7% were misclassified as False(−) by SCREEN-III. The False(−) group did not differ significantly from the True(−) group. Based on SCREEN-III, 45.3% of individuals were at nutrition risk, 44% of whom reported the outcome composite. SCREEN-III nutrition risk was associated with greater odds of the outcome composite compared to those not at-risk (OR = 1.40, 95% CI = 1.33, 1.48, P < 0.0001).


The proposed version of SCREEN-III demonstrated construct validity, but misclassification of risk may be problematic; further validation of a 3-item version is recommended.

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SCREEN-II, SCREEN-II-AB and other versions are freely available to researchers and clinicians.

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This research was made possible using the data/biospecimens collected by the Canadian Longitudinal Study on Aging (CLSA). Funding for the Canadian Longitudinal Study on Aging (CLSA) is provided by the Government of Canada through the Canadian Institutes of Health Research (CIHR) under grant reference: LSA 9447 and the Canada Foundation for Innovation. This research has been conducted using the CLSA dataset Baseline Tracking Dataset version 3.3, Baseline Comprehensive Dataset version 3.2, under Application Number 170602. The CLSA is led by Drs. Parminder Raina, Christina Wolfson, and Susan Kirkland

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  1. Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada

    • Jill M. Morrison
    •  & Heather H. Keller
  2. School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada

    • Celia V. Laur
  3. Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada

    • Heather H. Keller


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The authors declare that they have no conflict of interest.

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Correspondence to Jill M. Morrison.

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