Advancing early identification of at-risk children: a consensus-based refinement and validation roadmap for the pediatric malnutrition screening algorithm.

Authors

Robert D Murray, Sanaa Y Shaaban, Abdullah Shamsah, Ahmed Al Hammadi, Ahmed Amin, Ali Almehaidib, Ehab Khairy Elkhashab, Ekaterina A Pyrieva, Entesar Al Hammadi, Funda Çetin, Khoula Al-Said, Muslim AlSaadi, Naglaa M Kamal, Eslam Tawfik ElBaroudy

Published in

Frontiers in nutrition. Volume 13. Pages 1857903. Epub Sep 09, 2026.

Abstract

Mild malnutrition risk remains an underrecognized yet clinically important contributor to impaired growth and development in children aged 1-10 years across the Middle East. Regional estimates indicate that 15-25% of children in the Gulf Cooperation Council (GCC) fall within the mild malnutrition risk category (Weight-for-Height Z-score [WHZ] between -1 and -2 SD), a subgroup vulnerable to progressive growth faltering yet excluded from conventional malnutrition diagnostic thresholds (WHZ < -2 SD). The Pediatric Malnutrition Screening Algorithm (PMSA-2025) was refined through a structured regional expert consensus process to enable early, standardized detection of these at-risk children in outpatient and community healthcare settings.
A 14-member multidisciplinary expert panel from different countries (KSA, UAE, Egypt, Kuwait, Oman, Russia, United States, and Türkiye) refined the PMSA-2025 using a three-round, hybrid modified Delphi approach conducted in September 2025. Expert selection criteria included a minimum of 10 years of clinical or academic experience in pediatric nutrition or gastroenterology, active involvement in malnutrition-related clinical practice or research, and representation of diverse regional healthcare contexts. Content validity was assessed using the Item-level Content Validity Index (I-CVI), with a threshold of ≥0.80 for domain retention. Six clinical domains were retained from an initial pool of eight candidate domains after Delphi-based consensus: perinatal history, growth trajectory, prior nutritional diagnosis, hospitalization frequency, infection recurrence, and feeding behavior. Each domain was operationalized with measurable, age-appropriate criteria and incorporated into a binary (Yes/No) scoring system (total score: 0-6). The tool is designed for use by pediatricians, family physicians, nurses, and trained community health workers in children aged 1-10 years with WHZ between -1 and -2 SD. Exclusion criteria include children with primary chronic systemic disease driving growth impairment and those already receiving formal nutritional support.
All six retained domains achieved an Item-level CVI (I-CVI) ≥ 0.85 in the final consensus round. Two initial candidate domains (dietary diversity score, caregiver nutritional literacy) were excluded due to insufficient agreement (I-CVI < 0.70). Three domains required definitional refinement during Round 2, achieving ≥90% final agreement in Round 3. The PMSA-2025 stratifies mild malnutrition risk across three tiers: low (0-1), moderate (2-3), and high (4-6). It requires no specialized equipment beyond a standard scale and can be completed within routine consultations.
The PMSA-2025 represents a consensus-based, multidimensional screening tool with established content validity designed to address the unmet need for early mild malnutrition risk identification in outpatient and community pediatric settings across the Middle East.

PMID:
42781358
Bibliographic data and abstract were imported from PubMed on 25 Sep 2026.

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