This research is part of an ongoing program, Nutrition Screening Tool for Every Preschooler (NutriSTEP®). NutriSTEP® is a valid and reliable 17-item, parent-administered, questionnaire for nutritional risk in preschoolers (3-5 years of age). Due to an expressed need across Canada, the specific objective of this research was to create a draft toddler (18-35 month) NutriSTEP®. Based on results from a comprehensive literature review, focus groups (n=6) with 48 parents of toddlers, and input from 13 pediatric nutrition experts, many questions from the original preschooler NutriSTEP® questionnaire were refined or removed, and novel questions were added. Basic changes included combining separate fruit and vegetable intake questions, and adding breast milk and formula as examples of dairy products. In conclusion, a 19 item Toddler NutriSTEP® was created to reflect the differences in nutritional risk between preschoolers and toddlers. Next steps in the development process include refinement, test-retest reliability and criterion validation. / Canadian Institutes of Health Research

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This research represents phase C in the development of Toddler NutriSTEP® (Nutrition Screening Tool for Every Preschooler). NutriSTEP® is a valid and reliable screening tool designed to assess nutritional risk in preschoolers (3-5 years). A draft toddler (18-35 months) version of NutriSTEP® has recently been developed because of an expressed need. Convenience samples of caregivers were recruited across Ontario to assess the test-retest reliability and construct validity of the tool. Test-retest reliability was assessed based on total score and attribute scores using paired sample t-tests and intraclass correlation coefficients; individual questions were assessed using Wilcoxcon signed rank tests and kappa statistics. Construct validity was assessed through comparison of high-risk groups to Toddler NutriSTEP® scores, as well as through exploratory and confirmatory factor analyses. Toddler NutriSTEP® was found to be test-retest reliable and construct valid, and therefore may be used to assess nutritional risk in Canadian toddlers. / Funded by the Canadian Institutes of Health Research

Malnutrition is a significant issue affecting the health of many adults over the age of 65. Screening for malnutrition in this population can help identify those in need of a complete nutritional assessment. Many screening tools have been developed to aid healthcare team members in identifying those at risk for malnutrition. A population of dietitians with a focus in older adult nutrition was surveyed to determine dietitians’ perceptions and use of screening tools for the older adult. The results of the study showed many dietitians did not use validated screening tools at their place of work and were not confident in their knowledge regarding the topic. Despite dietitians’ having the expertise in nutrition, other interdisciplinary team members are performing the screening in many settings in the United States and some dietitians’ feel this is an obstacle in identifying older adults at risk.

Literature Review Undernutrition in the hospital setting has been shown to cause adverse outcomes. Screening for nutritional risk assists in the detection of undernutrition with subsequent early intervention to prevent further decline. While many nutrition screening tools exist, none are proven to detect undernutrition. Furthermore, many barriers exist for utilizing nurses as primarily responsible for screening patients for nutritional risk. Background A hospital reviewed the nutrition screening process and found that the form used and screening factors were insufficient to adequately detect undernutrition and appropriate referrals for dietitians. Objectives 1) Determine if nursing compliance improved when the nutrition screening form was integrated with the Interdisciplinary Care Plan form. 2) Improve the relevance of the nutrition screening risk factors used and the overall screening tool. Methods The Interdisciplinary Plan of Care form was updated to include the nutrition screening tool and used on the Medical /Surgical unit. Data was also collected on the Intensive Care Unit which continued to use the original screening tool. Results Screening completion did not improve with the implementation of the new screening process, however the quality and quantity of referrals from the new screening form did improve. Total compliance for nurses responsibility also improved with the new form. Conclusion Integrating nutrition screening factors into an interdisciplinary plan of care can improve the rate of dietitian referrals. Nutritional screening procedures must be continually reevaluated for effectiveness in detecting undernutrition in the hospitalized patient. Further studies must be conducted to evaluate the validity and specificity of all nutrition screening tools.

Background: Hospital malnutrition is a prevalent issue with critically ill pediatric patients being at increased risk for nutritional loss. Nutritional risk screening has been associated with increased documentation of nutrition diagnosis and positive clinical outcomes, however, is not mandatory in developing countries. A nutrition screening tool that uses subjective examination of loss of subcutaneous fat and muscle tissue may be an efficient way to identify nutritional risk in hospitalized critical care pediatric patients. Objective: To determine whether loss of subcutaneous fat and muscle tissue in specific body locations was associated with moderate or severe malnutrition determined by SGA in pediatric critical care hospital units, and if loss of subcutaneous fat and muscle tissue differs by gender, age, or disease. Methods: Pediatric in-patients (n = 203), aged 1 month to 18 years old, in tuberculosis, burn, oncology, high dependency (HDU) and intensive care units (ICU) in two tertiary hospitals in Malawi were assessed for nutritional status using Subjective Global Assessment (SGA), Mid-upper arm circumference (MUAC), and weight for age Z-score (WAZ). The SGA form included four questions on weight, appetite, tolerance to food and fluids, and dietary intake, as well as a nutrition-focused physical exam. The nutrition-focused physical exam consisted of assessments of subcutaneous fat loss in two locations (below the eye, triceps/biceps) and eight locations for muscle tissue loss (temple, clavicle, shoulder, scapula, interosseous, knee, quadriceps, and calf). The analysis was focused on the assessment of loss of subcutaneous fat and muscle tissue in relation to malnutrition score determined by SGA. Results: The mean age and standard deviation of the study population was 5.32 years ± 4.80, with just over 55% of participants being male. Determined by SGA, moderate malnutrition prevalence was 70.9% and severe malnutrition prevalence was 13.8%. SGA alone identified more malnutrition (84.7%) than MUAC (20.5%) and WAZ (43%). Patients with cancer (100%) and organ-related disease (93.76%) had the highest rates of moderate and severe malnutrition. Loss of subcutaneous fat and muscle tissue in all body locations assessed were associated with moderate and severe malnutrition (p-value Conclusions: A nutritional screening tool that is efficient, valid, and allows for the screening of a large patient population in a short amount of time, is needed in Malawi. Although loss of subcutaneous fat and muscle tissue were significantly associated with moderate and severe malnutrition, moderate loss of muscle tissue in the quadriceps and calf had the highest odds of malnutrition. These results indicate that pediatric patients with moderate loss of muscle tissue in their quadriceps and calf should be treated with a high index of suspicion for malnutrition. While loss of subcutaneous fat and muscle were not significantly worse by gender, age, or disease, particular attention should be paid in patients of the male sex, aged 6 to 10 years old, and with cancer. These findings support increasing dietetic services to prevent and treat hospital malnutrition using simple screening tools, such as the one used in this sub-analysis.

Contexte : La détérioration de l’état nutritionnel liée à la perte d’autonomie qui accompagne l’évolution de la démence du type Alzheimer (DTA) peut être limitée par un proche aidant efficace. À long terme, le rôle soignant du proche aidant peut affecter sa propre santé physique et psychologique. Objectifs : (1) décrire les caractéristiques sociodémographiques des patients et de leurs proches aidants; (2) examiner l’évolution de la maladie et des variables à l’étude au cours de la période de suivi; (3) explorer la relation possible entre le fardeau perçu du proche aidant, l’état nutritionnel des patients et la stabilité du poids corporel du proche aidant. Hypothèses : L’absence du fardeau chez l’aidant est associée à un meilleur état nutritionnel chez le patient; la détérioration de la fonction cognitive chez le patient s’accompagne d’une augmentation du fardeau perçu par l’aidant; la dégradation du fardeau chez l’aidant conduit à sa perte de poids. Méthode : Les données analysées proviennent de l’étude « Nutrition-mémoire » menée entre 2003 et 2006 dans les trois cliniques de cognition situées dans des hôpitaux universitaires à Montréal. Quarante-deux patients avec une DTA probable vivant dans la communauté et leurs aidants ont été suivis en dyades pendant une période de dix-huit mois. Les analyses ont porté sur les données colligées du recrutement à douze mois plus tard en raison du nombre restreint des patients interviewés à la dernière mesure. La relation entre le fardeau de l’aidant et les variables caractérisant l’état nutritionnel chez les patients a été évaluée à l’aide des analyses de corrélations, du test khi-carré ou du test de Fisher. L’état cognitif des patients était évalué à l’aide du score au Mini-Mental State Examination, le fardeau de l’aidant était estimé par le score au « Zarit Burden Interview », l’état nutritionnel des patients était défini par la suffisance en énergie et en protéines, le score à l’outil de dépistage nutritionnel des aînés, le poids et l’indice de masse corporelle des patients. Résultats : Le fardeau perçu des aidants était associé à la suffisance en énergie chez les patients. Le nombre de patients ayant des apports insuffisants en énergie était plus important chez les dyades où les aidants percevaient un fardeau plus élevé. Toutefois, aucune association n’a été observée entre le fardeau des aidants et le risque nutritionnel ou la suffisance en protéines chez les patients. La détérioration de la fonction cognitive des patients ne semble pas avoir provoqué une augmentation du fardeau chez leurs aidants. De plus, l’augmentation du fardeau de l’aidant n’était pas accompagnée d’une perte de son poids corporel. Par ailleurs, un fardeau plus important a été observé chez les aidants des patients obèses ou présentant un embonpoint. Conclusion : La réduction du fardeau perçu des aidants permettrait d’améliorer les apports alimentaires des patients et ainsi de limiter ou minimiser le risque de détérioration de leur état nutritionnel et de perte de poids. / Background: The progressive decline in nutritional status related to the loss of autonomy commonly observed in Alzheimer’s disease (AD) may be limited by an effective caregiver. In the long term, the caregiver’s role may affect his own physical and psychological health. Objectives: (1) to describe the demographic characteristics of patients and their caregivers; (2) to examine the evolution of the disease and study variables during the follow-up period; (3) to explore the possible relationship between the caregiver’s perceived burden, the nutritional status of patients and the stability of caregiver’s body weight. Hypotheses: The absence of caregiver burden is associated with better nutritional status in patients; the decline of cognitive function in patients is accompanied by an increase in the caregiver’s perceived burden; and an increased caregiver burden leads to a loss of body weight. Methods: We analysed data from the “Nutrition-memory” study carried out between 2003 and 2006 in the three university hospital memory clinics in Montréal. Forty-two community dwelling patients with probable AD and their informal caregivers were followed as dyads for a period of eighteen months. Analyses focused on data collected from recruitment to twelve months later because of the limited number of patients interviewed at the last measurement. The relation between caregiver burden and the variables characterizing the nutritional status in patients was assessed using correlation analysis, chi-square test or Fisher’s exact test. The patient’s cognitive function was assessed using the Mini-Mental State Examination, caregiver burden was estimated by the Zarit Burden Interview, and the nutritional status of patients was defined by their adequacy in energy and proteins intake, the elderly nutrition screening score, weight and body mass index of patients. Results: The caregiver’s perceived burden was associated with the energy adequacy in patients. The number of patients with inadequate intake of energy was higher among dyads caregivers who perceived a higher burden. No association was found between the caregiver’s burden and the nutritional risk or protein adequacy in patients. The deterioration of patient’s cognitive function does not seem to have led to an increased caregiver burden. In addition, increased caregiver burden was not accompanied by weight loss. Moreover, a greater burden was observed among caregivers of patients who were overweight or obese. Conclusion: Reducing perceived caregiver burden could improve dietary intake of patients and thereby limit or minimize the risk of deterioration of their nutritional status and weight loss.

Contexte : La détérioration de l’état nutritionnel liée à la perte d’autonomie qui accompagne l’évolution de la démence du type Alzheimer (DTA) peut être limitée par un proche aidant efficace. À long terme, le rôle soignant du proche aidant peut affecter sa propre santé physique et psychologique. Objectifs : (1) décrire les caractéristiques sociodémographiques des patients et de leurs proches aidants; (2) examiner l’évolution de la maladie et des variables à l’étude au cours de la période de suivi; (3) explorer la relation possible entre le fardeau perçu du proche aidant, l’état nutritionnel des patients et la stabilité du poids corporel du proche aidant. Hypothèses : L’absence du fardeau chez l’aidant est associée à un meilleur état nutritionnel chez le patient; la détérioration de la fonction cognitive chez le patient s’accompagne d’une augmentation du fardeau perçu par l’aidant; la dégradation du fardeau chez l’aidant conduit à sa perte de poids. Méthode : Les données analysées proviennent de l’étude « Nutrition-mémoire » menée entre 2003 et 2006 dans les trois cliniques de cognition situées dans des hôpitaux universitaires à Montréal. Quarante-deux patients avec une DTA probable vivant dans la communauté et leurs aidants ont été suivis en dyades pendant une période de dix-huit mois. Les analyses ont porté sur les données colligées du recrutement à douze mois plus tard en raison du nombre restreint des patients interviewés à la dernière mesure. La relation entre le fardeau de l’aidant et les variables caractérisant l’état nutritionnel chez les patients a été évaluée à l’aide des analyses de corrélations, du test khi-carré ou du test de Fisher. L’état cognitif des patients était évalué à l’aide du score au Mini-Mental State Examination, le fardeau de l’aidant était estimé par le score au « Zarit Burden Interview », l’état nutritionnel des patients était défini par la suffisance en énergie et en protéines, le score à l’outil de dépistage nutritionnel des aînés, le poids et l’indice de masse corporelle des patients. Résultats : Le fardeau perçu des aidants était associé à la suffisance en énergie chez les patients. Le nombre de patients ayant des apports insuffisants en énergie était plus important chez les dyades où les aidants percevaient un fardeau plus élevé. Toutefois, aucune association n’a été observée entre le fardeau des aidants et le risque nutritionnel ou la suffisance en protéines chez les patients. La détérioration de la fonction cognitive des patients ne semble pas avoir provoqué une augmentation du fardeau chez leurs aidants. De plus, l’augmentation du fardeau de l’aidant n’était pas accompagnée d’une perte de son poids corporel. Par ailleurs, un fardeau plus important a été observé chez les aidants des patients obèses ou présentant un embonpoint. Conclusion : La réduction du fardeau perçu des aidants permettrait d’améliorer les apports alimentaires des patients et ainsi de limiter ou minimiser le risque de détérioration de leur état nutritionnel et de perte de poids. / Background: The progressive decline in nutritional status related to the loss of autonomy commonly observed in Alzheimer’s disease (AD) may be limited by an effective caregiver. In the long term, the caregiver’s role may affect his own physical and psychological health. Objectives: (1) to describe the demographic characteristics of patients and their caregivers; (2) to examine the evolution of the disease and study variables during the follow-up period; (3) to explore the possible relationship between the caregiver’s perceived burden, the nutritional status of patients and the stability of caregiver’s body weight. Hypotheses: The absence of caregiver burden is associated with better nutritional status in patients; the decline of cognitive function in patients is accompanied by an increase in the caregiver’s perceived burden; and an increased caregiver burden leads to a loss of body weight. Methods: We analysed data from the “Nutrition-memory” study carried out between 2003 and 2006 in the three university hospital memory clinics in Montréal. Forty-two community dwelling patients with probable AD and their informal caregivers were followed as dyads for a period of eighteen months. Analyses focused on data collected from recruitment to twelve months later because of the limited number of patients interviewed at the last measurement. The relation between caregiver burden and the variables characterizing the nutritional status in patients was assessed using correlation analysis, chi-square test or Fisher’s exact test. The patient’s cognitive function was assessed using the Mini-Mental State Examination, caregiver burden was estimated by the Zarit Burden Interview, and the nutritional status of patients was defined by their adequacy in energy and proteins intake, the elderly nutrition screening score, weight and body mass index of patients. Results: The caregiver’s perceived burden was associated with the energy adequacy in patients. The number of patients with inadequate intake of energy was higher among dyads caregivers who perceived a higher burden. No association was found between the caregiver’s burden and the nutritional risk or protein adequacy in patients. The deterioration of patient’s cognitive function does not seem to have led to an increased caregiver burden. In addition, increased caregiver burden was not accompanied by weight loss. Moreover, a greater burden was observed among caregivers of patients who were overweight or obese. Conclusion: Reducing perceived caregiver burden could improve dietary intake of patients and thereby limit or minimize the risk of deterioration of their nutritional status and weight loss.