Abstract
Globally, millions of children live with intellectual and developmental disabilities (IDD), which can raise the risk of malnutrition in children. Data from Saudi Arabia on school-aged children with IDD remain limited. Therefore, this study aimed to determine the prevalence of malnutrition among school-aged children with and without IDD in Saudi Arabia. This cross-sectional study was conducted during August-December of 2024 at the Child Development Center at University Hospital, Riyadh, Saudi Arabia. School-aged children (5-17 years) with clinician-diagnosed autism spectrum disorder (ASD), Down syndrome (DS), attention deficit/hyperactivity disorder (ADHD), or cerebral palsy (CP) and age-matched children without IDD were recruited. Weight and height were measured, and body mass index (BMI) was calculated. WHO Growth Reference 2007 (5-19 years) was used to generate BMI-for-age z-scores (BAZ) and height-for-age z-scores (HAZ) using WHO AnthroPlus; weight-for-age z-scores (WAZ) were computed only for children aged ≤ 10 years. Malnutrition was defined as undernutrition (thinness and/or stunting and/or underweight) and/or overnutrition (overweight and/or obesity). A total of 168 children participated (IDD, n = 68; non-IDD, n = 100). Overall malnutrition prevalence was similar in children with and without IDD (47% vs. 48%; risk ratio [RR] 0.98, 95% CI 0.71-1.36; p = 0.905). Overnutrition was more common than undernutrition in both groups (IDD: 29% overnutrition vs. 25% undernutrition; non-IDD: 32% vs. 28%). Although overall prevalence was comparable, marked heterogeneity was observed across IDD subtypes (malnutrition: DS 90%, ADHD 50%, CP 48%, ASD 24%; χ (2) (3) = 12.02, p = 0.007; FDR-adjusted q = 0.022). Concurrent stunting and overweight/obesity (individual-level double burden) was observed in 12% of non-IDD children and 7% of children with IDD. In conclusion, nearly half of this hospital-based sample of Saudi school-aged children had evidence of malnutrition, with overnutrition exceeding undernutrition. While overall malnutrition prevalence did not differ between children with and without IDD, the distribution across IDD subtypes was clinically meaningful. Routine growth monitoring and targeted nutrition support are needed in both clinical and school settings.