Anthropometric Assessment of Malnutrition in a Pediatric Tertiary Outpatient Setting

Background/Objectives: Pediatric malnutrition remains a significant concern, particularly among children with chronic diseases attending tertiary care centers. Accurate identification using anthropometric parameters is essential for timely nutritional intervention. Methods: A single-center, retrospective study was conducted at Istanbul Faculty of Medicine, including 1511 children (44.4% girls; median age was 123.2 months (IQR: 67.7–170.9); age did not differ between boys and girls) attending Pediatric Gastroenterology and Nutrition (PGN) and Pediatric Nephrology (PN) outpatient clinics between September 2015 and July 2016. Anthropometric Z-scores—height-for-age (HFA), weight-for-age (WFA), weight-for-height/length (WFH/L), and body mass index (BMI)—were calculated using national reference standards, and mid-upper arm circumference (MUAC) was calculated using international references. Malnutrition was classified according to the 2022 ESPGHAN position statement (Z ≤ −2). A subgroup of 160 patients with 6-month follow-up data was analyzed longitudinally, comparing outcomes between standard dietary counseling (SDC, n = 138) and supplementary/exclusive enteral nutrition (SEN + EEN, n = 22) groups. Results: Moderate-to-severe acute malnutrition (Z ≤ −2) was present in 7.9%, stunting in 20.6% and mixed malnutrition in 3.1% of children. The prevalence of stunting was similar in children < 60 and ≥60 months (21.8% vs. 20.2%). Malnutrition severity varied by underlying disease, with neurologic disorders carrying the highest burden (26.7% with severe and 38.3% with moderate-to-severe acute malnutrition). The SEN + EEN subgroup had substantially lower baseline anthropometric Z-scores. Over six months, the SDC group showed a small improvement in HFA and declines in BMI and MUAC, whereas no significant within-group changes were observed in the SEN + EEN group. Conclusions: Malnutrition is highly prevalent among children with chronic diseases, with chronic malnutrition affecting 20.6%. In the subgroup, no significant between-group difference was observed after baseline adjustment. Routine anthropometric screening, including MUAC, may help identify children who require further nutritional assessment.