A child feeding index is superior to WHO IYCF indicators in explaining length-for-age Z-scores of young children in rural Cambodia

BACKGROUND Adequate young child feeding practices are influenced by a multitude of factors which affect growth and development. A combination of indicators is needed to explain the role of complementary feeding practices in growth retardation. METHODS A cross-sectional nutrition baseline survey was conducted in rural Cambodia in September 2012. Villages in pre-selected communes were randomly selected using stunting as a primary indicator. Data were collected from 803 randomly selected households with children aged 6-23 months, based on a standardised questionnaire and on length/height and weight measurements of mother and child. WHO Infant and Young Child Feeding (IYCF) indicators [minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD)] and a child feeding index (CFI) were created. The latter consisted of five components: breastfeeding, use of bottle, dietary diversity, food frequency and meal frequency which were adjusted for three age groups: 6-8, 9-11 and 12-23 months. The highest possible score was 10. Associations between length-for-age Z-scores (LAZ) and WHO indicators or CFI were explored. RESULTS Mean (SD) LAZ was -1·25 (1·14) (n  =  801). Mean (range) CFI was 6·7 (1-10) (n  =  797). Mean CFI was highest in the 9-11-months age group (7·93) and lowest for those aged 12-23 months (5·96). None of the WHO IYCF indicators was associated with LAZ, whereas CFI showed significant association with LAZ (P < 0·01). The association between higher CFI scores and LAZ became weaker as age increased. CONCLUSION The results highlight the need to include a wide range of information in the analysis in order to understand the association between appropriate infant feeding practices and child growth.