Development, reliability, and validity testing of Toddler NutriSTEP: a nutrition risk screening questionnaire for children 18–35 months of age

Abstract

Nutrition is vital for optimal growth and development of young children. Nutrition risk screening can facilitate early intervention when followed by nutritional assessment and treatment. NutriSTEP (Nutrition Screening Tool for Every Preschooler) is a valid and reliable nutrition risk screening questionnaire for preschoolers (aged 3-5 years). A need was identified for a similar questionnaire for toddlers (aged 18-35 months). The purpose was to develop a reliable and valid Toddler NutriSTEP. Toddler NutriSTEP was developed in 4 phases. Content and face validity were determined with a literature review, parent focus groups (n = 6; 48 participants), and experts (n = 13) (phase A). A draft questionnaire was refined with key intercept interviews of 107 parents/caregivers (phase B). Test-retest reliability (phase C), based on intra-class correlations (ICC), Kappa (κ) statistics, and Wilcoxon tests was assessed with 133 parents/caregivers. Criterion validity (phase D) was assessed using Receiver Operating Characteristic (ROC) curves by comparing scores on the Toddler NutriSTEP to a comprehensive nutritional assessment of 200 toddlers with a registered dietitian (RD). The Toddler NutriSTEP was reliable between 2 administrations (ICC = 0.951, F = 20.53, p < 0.001); most questions had moderate (κ ≥ 0.6) or excellent (κ ≥ 0.8) agreement. Scores on the RD nutrition risk rating and the Toddler NutriSTEP were correlated (r = 0.67, p < 0.000). The area under the ROC curve for moderate and high RD risk ratings were 84.6% and 82.7%, respectively. Cut-points of ≥21 (sensitivity 86%; specificity 61%) (moderate risk) and ≥26 (sensitivity 95%; specificity 63%) (high risk) were determined. The Toddler NutriSTEP questionnaire is both reliable and valid for screening for nutritional risk in toddlers.

Iron deficiency among low income Canadian toddlers: a cross-sectional feasibility study in a Community Health Centre and non-Community Health Centre sites

“…Parents completed the study instruments, including one based on the Canadian Community Health Survey, [ 23 ] addressing child and family characteristics, child diet and health behaviours and the NutriSTEP® questionnaire, a 17-item validated nutritional risk assessment tool [ 24 , 25 ]. Child weight and height were assessed - according to standardized anthropometric protocols [ 26 ].…”

Relative validity of a short food frequency questionnaire assessing adherence to the Norwegian dietary guidelines among colorectal cancer patients

“…In recent years, a number of short FFQs have been developed to monitor adherence to food recommendations ( 11 , 21 – 27 ); however, none of these assess adherence to a national FBDG. As part of the ongoing CRC-NORDIET study ( 7 ), we developed a short semi-quantitative FFQ (NORDIET-FFQ), designed to estimate the adherence to the Norwegian FBDG.…”

Association of Family Income and Risk of Food Insecurity With Iron Status in Young Children

“…Family income was collected in 4 categories, with the lowest income category and the lower middle income category approximating the low income cutoff (CAD $44 266 [$32 684] for a 4-person household) and the median family income (CAD $82 859 [$61 180] for a 4-person household), respectively, for Toronto, Canada. 37 Family risk of FI was collected using 2 approaches, as follows: a 1-item question used to screen for risk of FI from the NutriSTEP questionnaire 34 39 and an affirmative response to either of the 2 items has a sensitivity of 97% and specificity of 83% for identifying families at risk of FI, using the 18-item HFSSM as the criterion measure. 40 Our group previously validated the 1-item NutriSTEP question using the 2-item Hunger Vital Sign as the criterion measure.…”