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

Document Type : Research Paper


1 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Student Research Committee, Varastegan Institute for Medical Sciences, Mashhad, Iran.

4 Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.

5 Service of Clinical Nutrition and Dietitian, Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

6 Department of Nutrition Improvement, Faculty of Health Center, Mashhad University of Medical Science, Mashhad, Iran.

7 Department of Pediatrics Mashhad University of Medical Sciences Mashhad Iran.


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.


Main Subjects

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