Assessment of Nutritional Status and Malnutrition Risk Screening in Hospitalized Children: a prospective cohort study in a Tertiary Care Center.

Background and aims: Malnutrition in hospitalized children and adolescents, encompassing both undernutrition and overnutrition, remains a frequently under-recognized clinical concern. Nutritional impairment may be present at admission or worsen during hospitalization, particularly in children with underlying disease, inadequate intake, or increased nutritional requirements. Early nutritional assessment is therefore important to identify vulnerable patients and support timely intervention. This study aimed to assess nutritional status at admission, evaluate nutritional risk and feeding practices, and explore possible associations between nutritional status and clinical outcomes. Subjects and methods: This prospective pilot study was conducted in the Pediatric Emergency Ward of the University Hospital of Padua, Italy, over 24 weeks from February to July 2026. Children aged ≥1 month to <18 years were enrolled within 48 hours of hospital admission, with an expected length of stay >24 hours. Exclusion criteria included admission from Neonatal or Pediatric Intensive Care Units, eating or feeding disorders, refusal of consent, age <1 month, and admission to the study ward >48 hours after initial hospital presentation, including transfers or late identification. Nutritional status was assessed using weight, length/height, mid-upper arm circumference (MUAC), and age-appropriate weight-for-length/height, height-for-age and BMI-for-age z-scores. Z-scores were calculated using PediTools, applying WHO Child Growth Standards for children <24 months and CDC 2000 Growth Charts for those ≥24 months. Additional data included birth anthropometry, mode of delivery, gestational age when available, demographics, and reason for hospitalization. Nutritional risk was assessed using STRONGkids®. Early feeding practices were recorded in children <24 months, whereas Mediterranean diet adherence was assessed using KIDMED in children ≥24 months. Results: Of 227 children assessed, 125 (55.1%) were included. Median age was 16.0 months (IQR 7.0–42.0), and 57.6% were male. Overall, 100 children (80.0%) were well nourished, 11 (8.8%) undernourished, and 14 (11.2%) overnourished. Among undernourished children, 1 had isolated acute malnutrition, 8 isolated chronic malnutrition, and 2 both; considering the overlap, acute malnutrition was present in 3 children (2.4%) and chronic malnutrition in 10 (8.0%). Term birth was the only variable differing significantly across nutritional-status groups (p=0.028). STRONGkids classified 61 children (48.8%) as low risk, 61 (48.8%) as moderate risk, and 3 (2.4%) as high risk. After combining moderate and high risk, significant differences were observed for age as a continuous variable (p=0.022), age category (p=0.007), and reason for admission (p=0.016). Using moderate/high risk as a positive screening result, STRONGkids showed 100.0% sensitivity and 50.0% specificity for acute malnutrition, and 72.7% sensitivity and 50.9% specificity for any undernutrition. Median hospital stay was 4.0 days (IQR 3.0–6.0), and correlations between length of stay and anthropometric z-scores were weak and non-significant. Complementary feeding was introduced at a median age of 6.0 months (IQR 5.0–6.0); among 49 children assessed with KIDMED, adherence was predominantly moderate or high. Conclusions: Undernutrition and overnutrition were both present in our cohort, underscoring the need to assess the full spectrum of pediatric malnutrition at admission. STRONGkids was useful for identifying nutritional risk but should be used alongside objective anthropometric assessment, particularly as it does not capture overnutrition. Findings also suggest room for improvement in feeding practices and Mediterranean diet adherence. Larger studies are needed to confirm these preliminary results and support routine nutritional screening and timely intervention in hospitalized children.