An adaption of the NutriSTEP screening tool to be suitable for nutrition risk factor identification in New Zealand preschool children aged two to five years old; adaptation of NutriSTEP as a parent administered questionnaire : a thesis presented in partial fulfilment of requirements for the degree of Master of Science in Nutrition and Dietetics at Massey University, Albany, New Zealand

Abstract

Background: Risk factors of poor nutrition status in childhood may continue into adulthood and determine development of chronic disease. To reduce likelihood of chronic disease in adulthood, nutrition risk factors should be identified in childhood. Nutrition screening tools (NSTs) have been developed to identify increased nutrition risk and guide appropriate nutrition intervention. There is currently no reliable paediatric NST for use in the community setting in New Zealand (NZ). However, NutriSTEP, a validated parent-administered NST developed in Canada has been shown to identify preschool aged children at increased nutrition risk. Aim: To adapt the Canadian NutriSTEP to be suitable for use in the NZ setting, and to test its reliability, as a means to identify nutrition risk in preschool children aged between two and five years, as a parent administered questionnaire. Methods: New Zealand Registered Dietitians (NZRDs) (n=3) reviewed the wording of the Canadian NutriSTEP and suggested adaptions suitable for the NZ setting. Intercept interviews with parents of preschoolers (n=26) provided non-expert reviews of the Canadian NutriSTEP. NZRDs participated in a second review to evaluate suggested wording adaptions from the parent intercept interviews. Appropriate wording amendments were confirmed and the adapted NutriSTEP was finalised for online reliability testing. Parents of preschoolers (n=79) completed online administrations of the Canadian NutriSTEP and the adapted NutriSTEP four weeks apart in a blinded manner. Intraclass Correlation Coefficient (ICC) was then used to verify test-retest reliability between administrations of the NutriSTEP. Individual questionnaire items were verified for reliability between administrations through Cohen’s Kappa statistic (κ), Pearson’s chi-square value and Fisher’s exact test. Descriptive statistics identified preschoolers at increased (medium to high) nutrition risk and individual questionnaire items with the highest percentage of nutritional risk. Results: The Canadian NutriSTEP and adapted NutriSTEP were reliable between online administrations (ICC=0.91; 95% confidence interval 0.86, 0.94; F=11.4; P<0.000). Most (13 out of 17) questionnaire items had adequate (κ>0.5) agreement between administrations, one item had excellent agreement (κ>0.75). All individual questionnaire items had a p-value p<0.05 indicating a significant relationship between administrations. The Canadian NutriSTEP identified that 20.3% of preschoolers were at increased nutrition risk, whereas the adapted NutriSTEP identified that 31.6% were at increased nutrition risk. Individual questionnaire items with the highest percentage of nutritional risk included; low intake of breads and cereals (58.2%), milk and milk products (51.9%), meat and meat alternatives (40.5%), child sometimes not controlling the amount consumed (35.4%) and low vegetable intake (34.2%). Conclusions: The Canadian NutriSTEP and the adapted NutriSTEP were reliable between online administrations when verified for test-retest reliability in the NZ community setting. The adapted NutriSTEP identified more preschoolers at increased nutrition risk than the Canadian NutriSTEP. This demonstrates the adapted NutriSTEP has increased sensitivity in the NZ setting in comparison to the Canadian NutriSTEP. To identify increased nutrition risk in NZ preschoolers and reduce likelihood of chronic disease, the adapted NutriSTEP should be considered for future use in the community setting and to guide appropriate nutrition intervention by a NZRD.