Malnutrition remains one of the most significant public health challenges affecting the pediatric population worldwide, particularly in low- and middle-income countries. It encompasses a broad spectrum of nutritional disorders, including undernutrition (wasting, stunting, and underweight), micronutrient deficiencies, and overnutrition. Among children, malnutrition has profound implications on physical growth, cognitive development, immune competence, and long-term productivity, thereby perpetuating cycles of poverty and ill health [1]. Despite global efforts to reduce childhood malnutrition, its burden remains disproportionately high in developing regions. India bears a substantial share of the global malnutrition burden, accounting for a significant proportion of undernourished children under 18 years of age [2]. The pediatric age group represents a vulnerable population due to increased nutritional requirements during periods of rapid growth and development. Factors such as inadequate dietary intake, recurrent infections, poor maternal nutrition, suboptimal infant and young child feeding practices, low socioeconomic status, and limited access to healthcare services contribute significantly to malnutrition in children [3]. These determinants often coexist, compounding the risk and severity of nutritional deficits. Malnutrition during childhood is associated with increased morbidity and mortality from common infections such as diarrhea, pneumonia, and measles [4]. Chronic undernutrition, particularly stunting, is linked to impaired cognitive function, reduced school performance, and diminished earning potential in adulthood [5]. Acute malnutrition or wasting, on the other hand, significantly elevates the risk of mortality if not promptly identified and managed [6]. Therefore, early detection and timely intervention are crucial for improving child survival and development outcomes. The World Health Organization (WHO) recommends anthropometric indicators such as weight-for-age, height-for-age, and weight-for-height to assess nutritional status in children [7]. These indices allow for standardized classification of underweight, stunting, and wasting, enabling comparison across populations and over time. Understanding the incidence, prevalence, and patterns of malnutrition within specific pediatric age groups is essential for planning targeted nutritional interventions and policy formulation [8]. Although several national surveys provide estimates of malnutrition prevalence, local and hospital-based studies remain important for identifying region-specific patterns and high-risk groups [9]. Moreover, variations in malnutrition prevalence by age, sex, and socioeconomic factors highlight the need for disaggregated data to inform context-specific strategies [10]. The present study was undertaken to assess the incidence, prevalence, and patterns of malnutrition among the pediatric age group attending a tertiary care center. By analyzing anthropometric indicators across different age groups and genders, this study aims to provide valuable insights into the magnitude and distribution of pediatric malnutrition, thereby contributing evidence for improved child nutrition programs and clinical practices.

Study Design and Setting This was a hospital-based, cross-sectional observational study conducted in the Department of Pediatrics of a tertiary care teaching hospital over a period of 12 months. The study included children attending pediatric outpatient and inpatient services during the study period. Study Population Children aged 6 months to 18 years were included in the study. A total sample size of 500 children was enrolled using a consecutive sampling method. Inclusion Criteria • Children aged 6 months to 18 years • Children accompanied by a parent or legal guardian • Children whose caregivers provided informed consent Exclusion Criteria • Children with known chronic systemic illnesses (e.g., congenital heart disease, chronic kidney disease) • Children with genetic or metabolic disorders affecting growth • Children on long-term steroid therapy Data Collection A structured and pre-tested proforma was used to collect demographic details, including age, sex, and socioeconomic status. Anthropometric measurements were recorded by trained personnel using standardized techniques. Weight was measured using a calibrated digital weighing scale, and height/length was measured using a stadiometer or infantometer as appropriate. Assessment of Nutritional Status Nutritional status was assessed using WHO growth standards. The following indices were calculated: • Weight-for-Age (WFA) – to assess underweight • Height-for-Age (HFA) – to assess stunting • Weight-for-Height (WFH) – to assess wasting Children were classified as: • Normal (Z-score ≥ −2 SD) • Moderate malnutrition (Z-score between −2 and −3 SD) • Severe malnutrition (Z-score < −3 SD) Ethical Considerations Ethical clearance was obtained from the Institutional Ethics Committee prior to commencement of the study. Written informed consent was obtained from parents or guardians, and assent was obtained from older children where appropriate. Confidentiality of participant data was strictly maintained. Statistical Analysis Data were entered into Microsoft Excel and analyzed using SPSS software version 23.0. Descriptive statistics were used to summarize demographic and anthropometric variables. Categorical variables were expressed as frequencies and percentages. The prevalence of underweight, stunting, and wasting was calculated. Chi-square test was used to assess associations between nutritional status and demographic variables, with a p-value <0.05 considered statistically significant.

Table 1 demonstrates the age and gender distribution of the study population. The majority of children belonged to the 0.5–5 years age group (36%), followed by adolescents aged 11–18 years (34%). Male children constituted a slightly higher proportion (53%) compared to females (47%). The relatively balanced gender distribution across age groups reduces gender bias and allows meaningful comparison of malnutrition patterns between male and female children. Table 1: Age and Gender Distribution of Study Participants (n = 500) Age Group (years) Male n (%) Female n (%) Total n (%) 0.5–5 95 (19.0) 85 (17.0) 180 (36.0) 6–10 80 (16.0) 70 (14.0) 150 (30.0) 11–18 90 (18.0) 80 (16.0) 170 (34.0) Total 265 (53.0) 235 (47.0) 500 (100) As shown in Table 2, the overall prevalence of underweight, stunting, and wasting was 40%, 44%, and 32%, respectively. Moderate malnutrition constituted a larger proportion than severe forms across all indicators. Stunting was the most prevalent manifestation, indicating a high burden of chronic undernutrition. Severe malnutrition was observed in 10–14% of children, highlighting the need for early identification and intervention strategies. Table 2: Prevalence of Malnutrition Based on Anthropometric Indicators Nutritional Status Underweight n (%) Stunting n (%) Wasting n (%) Normal 300 (60.0) 280 (56.0) 340 (68.0) Moderate 130 (26.0) 150 (30.0) 110 (22.0) Severe 70 (14.0) 70 (14.0) 50 (10.0) Total 500 (100) 500 (100) 500 (100) Table 3 reveals that malnutrition was most prevalent among children aged 0.5–5 years. More than half of children in this age group were stunted, reflecting chronic nutritional deprivation during early childhood. The prevalence of underweight and wasting showed a declining trend with increasing age. These findings emphasize the critical importance of nutrition interventions during the first five years of life. Table 3: Age-wise Distribution of Malnutrition Age Group (years) Underweight n (%) Stunting n (%) Wasting n (%) 0.5–5 90 (50.0) 100 (55.6) 70 (38.9) 6–10 55 (36.7) 65 (43.3) 45 (30.0) 11–18 55 (32.4) 55 (32.4) 45 (26.5) Gender-wise analysis in Table 4 shows a higher prevalence of all forms of malnutrition among male children compared to females. Stunting was the most common form in both genders. The observed gender difference may reflect biological vulnerability of male children or differences in care-seeking behavior. However, the substantial prevalence among female children underscores the need for gender-inclusive nutritional interventions. Table 4: Gender-wise Distribution of Malnutrition Nutritional Indicator Male n (%) Female n (%) Underweight 115 (43.4) 85 (36.2) Stunting 125 (47.2) 95 (40.4) Wasting 90 (34.0) 70 (29.8)

The present study provides comprehensive data on the incidence, prevalence, and patterns of malnutrition among the pediatric age group attending a tertiary care hospital. The overall prevalence of undernutrition observed in this study remains alarmingly high, reflecting the persistent burden of childhood malnutrition in developing settings [11]. Stunting emerged as the most common manifestation, indicating long-standing nutritional deprivation and repeated exposure to adverse environmental conditions. The high prevalence of malnutrition among children aged 0.5–5 years observed in this study is consistent with earlier reports highlighting early childhood as a critical window for growth and development [12]. Inadequate complementary feeding practices, recurrent infections, and poor maternal nutrition are known contributors to undernutrition during this period [13]. The decline in malnutrition prevalence with increasing age may be attributed to improved dietary diversity and reduced vulnerability to infections as children grow older. Gender-wise analysis revealed a higher prevalence of malnutrition among male children. Similar findings have been reported in several studies, suggesting that male children may be biologically more susceptible to growth faltering under adverse conditions [14]. However, sociocultural factors influencing feeding practices and healthcare access cannot be overlooked [15]. Importantly, the substantial burden among female children in the present study highlights ongoing gender disparities and the need for equitable nutritional interventions. Stunting, reflecting chronic undernutrition, was more prevalent than wasting and underweight in this study. Chronic malnutrition has long-term consequences on cognitive development, educational attainment, and economic productivity [16]. The relatively lower prevalence of wasting compared to stunting suggests that acute malnutrition may be episodic, whereas chronic nutritional deficiencies persist over time. The findings of this study underscore the importance of routine growth monitoring and early nutritional screening in pediatric healthcare settings. Early identification of growth faltering allows timely counseling, supplementation, and referral, thereby preventing progression to severe malnutrition [17]. Community-based nutrition programs focusing on maternal education, optimal infant feeding practices, and food security remain essential for addressing the root causes of malnutrition [18]. Despite national nutrition initiatives, the persistence of high malnutrition prevalence indicates gaps in implementation and coverage. Strengthening primary healthcare systems, improving maternal literacy, and ensuring access to diversified diets are critical components of sustainable nutrition strategies [19]. Hospital-based data, as generated in this study, complement large-scale surveys by identifying high-risk groups requiring targeted interventions. The study has certain limitations, including its hospital-based design, which may limit generalizability to the wider community. Nevertheless, the findings provide valuable insights into the magnitude and patterns of pediatric malnutrition and reinforce the urgent need for integrated nutritional and public health interventions [20-25].

Malnutrition continues to be a major public health concern among the pediatric population, with a substantial proportion of children affected by underweight, stunting, and wasting. The present study highlights a high prevalence of malnutrition, particularly among children below five years of age, underscoring the vulnerability of early childhood. Stunting was identified as the most common form, reflecting chronic nutritional deprivation. Gender-wise differences indicate a slightly higher burden among male children, though both genders remain significantly affected. These findings emphasize the need for early detection, routine growth monitoring, and comprehensive nutrition programs targeting children and caregivers. Strengthening maternal education, improving infant and young child feeding practices, and enhancing healthcare access are crucial for reducing the burden of pediatric malnutrition. Timely and targeted interventions can significantly improve child growth, development, and long-term health outcomes.

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