A tool to describe diet and eating behaviour in children at risk of malnutrition : the International Complementary Feeding Evaluation Tool (ICFET)

Abstract

Purpose: The International Complementary Feeding Evaluation tool (ICFET) is a new tool that provides a standardised description of caregiver feeding and child eating behaviour and diet in young children. It is designed to be relevant to undernutrition in low- and-middle-income countries (LMICs) and to be valid in multiple languages. This paper aims to describe the full content of the ICFET and its performance in various settings, cross-sectionally and longitudinally. Method: ICFETs were completed by parents of 473 children aged 6-24 months in the UK, Kenya, Pakistan, and Guatemala. Repeated ICFETs were obtained for 62 children starting treatment for moderate acute malnutrition (MAM) in Kenya and Pakistan. Findings: Solids were started much earlier in the UK than other countries; in Kenya and Pakistan self-feeding was less, and force feeding more common than in Guatemala and the UK. In the LMIC samples only 23% children were eating foods from 5/8 of the recommended food groups daily. In the MAM treatment centres, Avidity was low: Kenya mean Z scores (SD) -1.76 (0.9); Pakistan -2.79 (0.9); and food refusal high: Kenya 0.77 (1.3), Pakistan 1.53 (0.9) compared to healthy UK infants, suggesting that they are capturing enduring appetitive characteristics; both showed moderate to good stability over time (Kenya Avidity Spearman’s r= 0.517, p= 0.023 Refusal r= 0.557, p=0.013; Pakistan Avidity r=0.959, p<0.001; Refusal 0.462 p=0.002). Conclusions: The ICFET provides valid eating and feeding behaviour measures which track within children over time, as well as a range of useful contextual measures of diet in the complementary feeding period