Beyond weight and height: Mid-upper arm circumference-based nutritional assessment and nutritional risk associated with clinical outcomes in hospitalized children and adolescents.

BACKGROUND

Hospitalized children with chronic and complex conditions are particularly vulnerable to nutritional deterioration, which has been associated with adverse clinical outcomes. Early identification of nutritional risk (NR) and nutritional status (NS) may support timely nutritional interventions; however, evidence on the combined use of STRONGkids and mid-upper arm circumference-for-age z-scores (zMUAC/A) in tertiary pediatric wards remains limited.

AIM: To evaluate the association of NR, NS, energy-protein adequacy, nutritional evolution, length of hospital stay (LOS), infection, and 30-day hospital readmission in children admitted to a tertiary pediatric ward.

METHODS

This prospective observational cohort included 216 children and adolescents (1 month-18 years) admitted to a tertiary teaching hospital in a low- and middle-income country. NR was assessed using STRONGkids, and NS was assessed using zMUAC/A. Associations between nutritional variables and clinical outcomes were evaluated using regression models and complementary statistical analyses.

RESULTS

The median age was 5.2 years, with a predominance of infants (34.7%) and males (55%). Undernutrition was more frequently identified by zMUAC/A than by zBMI/A (49.5% vs. 17.6%), and 31.5% of patients presented low height-for-age z-scores. STRONGkids demonstrated good performance for identifying undernutrition at admission (AUC = 0.858). Higher NR was associated with longer LOS and infection occurrence, whereas impaired NS was associated with infection occurrence and 30-day hospital readmission. Energy-protein adequacy and short-term nutritional evolution were not associated with the evaluated clinical outcomes. Overweight/obesity showed a descriptive trend toward shorter LOS than undernutrition; however, this finding should be interpreted cautiously because of the small subgroup size.

CONCLUSIONS

Hospitalized pediatric patients in this tertiary care setting presented a high burden of undernutrition and nutritional risk, both of which were associated with clinically relevant outcomes. The combined use of STRONGkids and MUAC-based nutritional assessment may improve the early identification of nutritionally vulnerable patients and support targeted nutritional interventions in children with complex clinical conditions.