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Progress in the Development of a Nutritional Risk Index^1,2,

Fredric D. Wolinsky^*, Rodney M. Coe, Wm. Alex McIntosh, Karen S. Kubena, John M. Prendergast^||, M. Noel Chavez^¶, Douglas K. Miller^**, James C. Romeis and Wendall A. Landmann

^* Department of Medicine, Indiana University Indianapolis Departments of Community Medicine ^** Department of Internal Medicine, Center for Health Services Education and Research, St. Louis University School of Medicine; Department of Sociology Department of Animal Science/Human Nutrition, Texas A & M University; ^|| Program on Aging, Mercy Hospital Pittsburgh ^¶ Department of Community Health Sciences, University of Illinois School of Public Health.

The development of a 16-item nutritional risk index (NRI) is chronicled from its inception through its application in three studies designed to assess its reliability and validity. Study I involved a survey of 401 community-dwelling elderly in St. Louis, Missouri who were interviewed at baseline, 4–5 mo later, and 1 yr later. Study II involved a cross-sectional survey of 377 male outpatients attending two clinics at the St. Louis Veterans Administration Medical Center. Study III involved a cross-sectional survey of 424 community-dwelling elderly in Houston, Texas. Internal consistency reliability coefficients ranged between 0.47 and 0.60, and test-retest reliability coefficients ranged between 0.65 and 0.71. Validity was established by using the NRI to predict the use of health services, as well as by correlating it with a variety of anthropometric, laboratory, and clinical markers of nutritional status. The utility of the NRI for future applications is discussed.

KEY WORDS: • nutritional risk • screening measures • field studies

¹ Presented as part of a conference, "Nutrition Monitoring and Nutrition Status Assessment", at the first fall meeting of the American Institute of Nutrition, Charleston, South Carolina, December 8–10, 1989. The conference was supported in part by cooperative agreement HPU880004-02-1 with the DHHS Office of Disease Prevention and Health Promotion, the USDA Human Nutrition Information Service, the DHHS National Center for Health Statistics, and the International Life Sciences Institute-Nutrition Foundation.

² The Planning Committee for the meeting consisted of Drs. Helen A. Guthrie, Roy J. Martin, Linda D. Meyers, James A. Olson, Catherine E. Woteki, and Richard G. Allison (ex officio). The symposium papers were edited by a committee consisting of Dr. James Allen Olson (coordinator), Dept. of Biochemistry & Biophysics, Iowa State University, Ames, IA; Dr. Cathy C. Campbell, Division of Nutritional Sciences, Cornell University, Ithaca, NY; Dr. Roy J. Martin, Dept. of Foods & Nutrition, University of Georgia, Athens, GA; and Dr. Catherine E. Woteki, Food & Nutrition Board, National Academy of Sciences, Washington, DC.

³ Supported in part by grants to Dr. Coe from the Alexian Brothers Hospital in St. Louis and the National Institute on Aging (K07-AG-00302), to Dr. Wolinsky by the National Institute on Aging (K04-AG-00328 and R01-AG-06618), to Dr. Prendergast by the Veterans Administration (HSR&D 84-017), and to Dr. McIntosh by the National Institute on Aging (R01-AG-04043). Each of the studies was approved by the appropriate Institutional Review Boards. Direct all correspondence to Dr. Wolinsky, Department of Medicine, Indiana University, 1001 West Tenth Street, Indianapolis, Indiana 46202-2859 (317) 630-7269.

Manuscript received 10 December 1989. Revision accepted 11 July 1990.

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