Dietary Screening Tool Used to Describe Diet Quality in Acquired Brain Injury and Parkinson's disease: An Exploratory Study
Authors: LoBuono Dara L. , Hurley Leah , Delmonico Matthew J , Xu Furong , Mahler Leslie , Lofgren Ingrid E 
Published: November 2023

Those living with acquired brain injury (ABI) and Parkinson's disease (PD) are at increased risk for malnutrition. The Dietary Screening Tool (DST) is validated in older adults to assess diet quality and nutritional risk using scores that range from 0–105, with higher scores indicating higher diet quality. The DST sub‐component scores include: whole fruit and juices, vegetables, lean protein, added sugars, fat and sweets, dairy, processed meat and use of a dietary supplement. Cutoff scores for nutrition risk are as follows: at risk (<60), possible risk (60–75), and not at risk (>75). DST data were obtained from 4 time points over 2 years from a 5‐year longitudinal study of persons with ABI and PD, and was used to assess how diet quality in 11 participants with PD and ABI changed over time. A repeated‐measure ANOVA revealed no significant change either in DST scores or its subcomponent across all 4‐time points. Participants remained at possible nutrition risk (F (3,30)=1.3, p=0.3, hp2=0.1). Mean DST scores ranged from 62.6±14.3 to 66.7±10.8. At time point 1 (TP1) 90.9% (n=8PD, 2ABI) of participants were at risk or possible nutrition risk, while at time point 4 (TP4), 72.7%(n=6PD, 2ABI) of participants were at risk or possible nutrition risk. An exploration of DST sub‐components was performed to further assess dietary intake. Sub‐scores were viewed as categorical variables with a score of ≥80% set as adequate intake. Cochran's q tests were performed to assess changes in adequate intake of each sub‐score overtime. There was a decrease in adequate lean protein from 45.5% at TP1 (n=3PD, 2ABI) to 36.4% (n=2PD, 2ABI, p=0.7) at TP4. Fruit intake remained the same overtime (27.3%, n=3PD, 2ABI, p=0.1); whole grain intake also remained the same overtime (45.5%, n=4PD, 1ABI, p=0.3). Thirty‐six percent of participants had adequate vegetable intake at TP1 (n=1PD, 3ABI), which increased to 45.5% of participants at TP4 (n=3PD, 2ABI, p=0.9). Adequate dairy consumption was reported in 18.2% participants with ABI at TP1 and in 36.4% of participants (n=3PD, 1ABI, p=0.7) at TP4. At TP1 only 45.5% (n=3PD, 2ABI) of participants were taking a daily multivitamin, while at TP4, 63.6% (n=4PD, 3ABI) of participants were taking a multivitamin (p=0.6). There was an increase in intake of added fat, sugar and sweets; at TP1 18.2% (n=1PD, 1ABI) of participants reported low intake and at TP4, only 9% (n=1 PD, p=0.4) of participants had low intake. Those who limited processed meat decreased from n=7 (6PD, 1ABI) to n=5 (4PD, 1 ABI, p=0.2) at TP4. Although many participants remained at possible nutrition risk, most were able to maintain or improve diet quality. While, not statistically significant, it is important to highlight diet quality can worsen overtime for those living with ABI and PD without intervention. Exploration of DST sub‐scores reveal participants may be opting for foods high in added fat, sugar and sweets, over fruits, dairy and lean protein. Monitoring of dietary quality and patterns in this population may be warranted, and referral to registered dietitians is appropriate. Future research is needed to validate DST sub‐scores to further assess dietary patterns.

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