Combined use of the pediatric Yorkhill malnutrition score and mid-upper arm circumference for identifying nutritional risk and predicting length of hospital stay in hospitalized children: a pilot study.

BACKGROUND: Childhood malnutrition remains a critical public health challenge among hospitalized pediatric populations, contributing to increased morbidity and prolonged length of hospital stay (LOS). In countries undergoing nutritional transition, such as Türkiye, the "double burden of malnutrition"-characterized by the coexistence of undernutrition and obesity-is exacerbated by socio-economic inequities. This study aimed to assess the prevalence and risk factors of malnutrition in hospitalized children and to evaluate the predictive validity of two rapid screening tools: the Pediatric Yorkhill Malnutrition Score (PYMS) and mid-upper arm circumference (MUAC), with attention to their utility in identifying socio-economic vulnerability. METHODS: This pilot study was conducted between January and July 2024 in a tertiary university hospital in Türkiye. A total of 100 children (50 girls, 50 boys), aged 1 month to 18 years, were evaluated. Nutritional status was assessed using World Health Organization (WHO) anthropometric Z-scores. Malnutrition risk was screened via PYMS and age-adjusted MUAC Z-scores. A novel socio-economic malnutrition risk classification was developed based on household income, family size, and maternal employment status. This pilot study tested the combined use of routine anthropometric measurements and practical screening tools such as PYMS and MUAC for a later large-scale, school-based screening. RESULTS: The double burden of malnutrition was evident: 13.0% had acute malnutrition and 11.0% chronic malnutrition (stunting); among children aged 5-18 years, 34.5% were overweight and 21.8% obese. The LOS was significantly longer in the PYMS high-risk group compared to the low-risk group (p = 0.001), and in the MUAC moderate malnutrition group (p < 0.05). PYMS demonstrated high specificity (95.89%) for acute malnutrition but limited sensitivity for stunting. Among children aged > 5 years, MUAC Z-scores correlated significantly with body mass index (BMI) Z-scores (p < 0.05). Children classified as high-risk by the socio-economic model had significantly lower height-for-age Z-scores (p < 0.05). CONCLUSIONS: This study highlights the impact of socio-economic inequities-such as low income and household overcrowding-on chronic malnutrition and confirms the clinical relevance of the double burden of malnutrition. PYMS and MUAC effectively predict prolonged hospitalization and adverse clinical outcomes. The integration of socio-economic risk assessment with routine malnutrition screening may guide equitable resource allocation and improve care for vulnerable pediatric populations.