Objective validation of a nutrition screening instrument in two rural communities

The Nutrition Screening Initiative (NSI) developed an instrument, the "Determine Your Nutritional Health" checklist, to identify the presence of risk factors for malnutrition among the elderly while promoting education about these risk factors. The purpose of this study was to validate the instrument's determination of nutritional risk against recognized anthropometric, biochemical, and physical indicators of malnutrition. Data were collected in two rural communities, one with a physician-ttaffed clinic and one with a small acutecare hospital/clinic. Free-living participants responded to a 43-item expansion of the Determine checklist and a nutrient specific food frequency measuring adherence to the Food Guide Pyramid and the Dietary Guidelines for Americans. A total of 119 subjects were interviewed, of which 89 (74.8%) agreed to have anthropometric measurements, a fasting blood draw, and a physical examination for clinical indicators of malnutrition. The mean age of the seniors who completed the study (61 females, 28 males) was 73.6 years, ranging from 58 to 89 years. Mean nutritional risk score by the Determine checklist was 4.58, which is within the moderate nutritional risk range (3 to 5). Mean scores for the clinic (4.22) and the hospital/clinic (4.98) communities did not significantly differ. The Determine checklist identified 78.6% (70 of 89) at nutritional risk. Correlation analysis showed that Determine score had limited association only with hemo^obin status (R=.2377, p=.0249) and glucose status (R=.2259, £=.0333). Internal reliability of the food frequency was acceptable (a=0.7375). Analysis of eating habits showed subjects ate foodshigh in sugar, sodium, fat, and fiber 1 to 2 times weekly, but reported low compliance with eating the recommended daily number of servings of foods from the bread and dairy groups. The "Determine Your Nutritional Health" checklist and the food frequency used in this study may be useful in identifying individual risk factors of nutritional health and eating habits associated with the Food Guide Pyramid and Dietary Guidelines for Americans, educating senior citizens, and directing them to appropriate social, medical, and nutritional services. However, the Determine checklist was found to have limited association with accepted objective measures of nutritional status among senior participants.