Nutrition is important to our overall health, however it is often overlooked! In all health care sectors, nutrition care is underutilized, often leading to increased morbidity and mortality. Nutrition risk screening is a means to quickly and easily identify whom may have nutrition problems. It is the first step in a comprehensive nutrition care program which will meet the nutrition needs of clients and patients.

Nutrition risk screening identifies those individuals “at risk” for impaired food intake and eventual poor nutrition status if intervention does not occur. Nutrition risk screening involves the identification of risk factors in a specific population group that could influence food intake and nutrition status. Risk factors will change with the population group. For example, in young children, slow transition to table foods would indicate risk, whereas in older adults, physical difficulties grocery shopping could point towards nutrition problems. In acute care, disease effects on nutritional status, inflammation, food intake, and functional and body composition changes are key risk indictors.

Quality nutrition risk screening tools are needed; they need to be valid, reliable, feasible and culturally appropriate. Professor Keller has been involved in the development and/or evaluation of several nutrition risk screening tools, including SCREEN© (Seniors in the Community Risk Evaluation for Eating and Nutrition) and NutriSTEP® (Nutrition Screening for Toddlers and Preschoolers).

A good screening tool is just the start! For screening to really change outcomes for clients/patients, interventions need to be put in place post screening. Implementation of an ethical screening program means that screening results in nutritional needs being met; care algorithms, referral plans and service mapping match up needs to interventions. Dr. Keller has been involved in developing screening programs and protocols to assist practitioners with use of these diverse tools.

Practitioners need to consider their ability to screen as well as the capacity of the system to provide interventions for those identified to be at risk. Targeted implementation and process evaluation of demonstration projects have helped to identify what is required to build capacity for screening. The Bringing Nutrition Risk Screening to Seniors (BNSS) in Canada project focused on evaluating targeted implementation of SCREEN I©. The BNSS Implementation Guide is located under Resources. A research brief has also been created to help SCREEN© users communicate screening results to older adults.

Targeted implementation and evaluation of NutriSTEP screening has also been completed in Ontario. Self- and assisted-referral models have been studied and compared. Parent perception of the screening and referral process was also assessed.

Dr. Keller is currently co-chair of the Canadian Malnutrition Task Force. CMTF is a group of clinicians and researchers and their mandate is to improve nutrition care in Canada. Working with stakeholder Partners Against Malnutrition, they are active in policy, knowledge translation and training to improve the nutritional care process. Acute care hospitals is the first part of the health sector to be addressed by CMTF. They are currently conducting a study on the prevalence, predictors, and outcomes of malnutrition and monitor the nutrition care process during and post hospitalization. Hospitals have been recruited from seven provinces and 1000 patients is the goal for data collection by the end of 2012.

Research Briefs

Communicating Screening Results

Bringing Nutrition Screening to Seniors Process Evaluation

Service Providers and Nutrition Screening

Research Articles

Keller HH. Promoting food intake in older adults living in the community: a review. App Phys Nutr Met 2007;32: 991-1000.

Keller HH, Haresign H, Brockest B. (2007). Bringing Nutrition Screening to Seniors (BNSS) Process Evaluation. Can J Diet Pract Res 68(2), 86-91.

Beath H, Keller HH. (2007). Nutrition screen showed good agreement when self- and interviewer-administered. J Clin Epi 60(10), 1085-89.

Keller HH, Brockest B, Haresign H. (2006). Building capacity for nutrition risk screening. Nutrition Today, 41(4), 164-70.

Keller HH. (2006)The SCREEN I (Seniors in the Community Risk Evaluation for Eating and Nutrition) index adequately represents nutritional risk. J Clin Epi 59(8), 836-841.

Keller HH, Goy R, Kane S-L. (2005). Validity and reliability of SCREEN II (Seniors in the Community: Risk Evaluation for Eating and Nutrition- version II). Eur J CLin Nutr 59, 1149-1167). Abstract

Bowman J, Keller H.H. (2005). Validation of the oral/nutrition status section of the Minimum Data Set 2.0 for long-term care residents. Can J Diet Res 66(3), 155-161).

Keller H.H., McKenzie J.D. (2003). Nutritional risk in vulnerable community-living seniors. Can J Diet Prac Res 64, 195-201. Abstract

Keller H.H., Allen, J. (2002). Ontario Older-Adult Programs: Self-Identified Interest in and Resources for Nutritional Risk Screening. Can J Aging 21(4), 587-594.

Keller H.H., McKenzie J.D., Goy R. (2001). Construct validation and test-retest reliability of the seniors in the community: risk evaluation for eating and nutrition questionnaire. J Gerontol: Med Sci 56A(9), M552-M558. Abstract

Keller H.H., Hedley M.R, Wong Brownlee S. (2000) Development of SCREEN – Seniors in the Community: Risk Evaluation for Eating and Nutrition. Can J Diet Prac Research 61(2), 67-72. Abstract