Evaluating the STRONGkids Tool for Assessing Malnutrition Risk in Hospitalized Iranian Children – A Cross-Sectional Study

Introduction: Malnutrition in hospitalized children can impair health outcomes. The STRONGkids screening tool requires further reliability testing across diverse healthcare providers to identify pediatric patients requiring nutritional support. This study evaluated the effectiveness of STRONGkids compared to standard anthropometric criteria in determining malnutrition risk among hospitalized Iranian children. Methods: This cross-sectional analysis evaluated 287 patients (mean age nine months) admitted for ≥4 days across all non-critical wards in a pediatric hospital in Mashhad, Iran, from November 2020 to October 2021. STRONGkids categories were compared to weight-for-age (WAZ), height-for-age (HAZ), BMI-for-age (BMIZ), and weight-for-length/height (WLZ/H) z-scores using agreement statistics. Results: The malnutrition rate exceeded previous estimates for Iranian pediatric patients. STRONGkids demonstrated statistically significant agreement with WLZ/H (p 0.001) and WAZ (p=0.014) in ruling out malnutrition risk. However, sensitivity for identifying high-risk cases was suboptimal. Conclusions: STRONGkids can reliably exclude malnutrition when agreement exists with anthropometric criteria. Standardizing training and administration of the tool could optimize sensitivity and utility for detecting hospitalized children requiring nutritional intervention.