PMSA-2025 screening tool achieves high content validity for identifying mild malnutrition in childrenNew screening tool helps identify mild malnutrition in young children

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  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  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.