First-ever tool to measure appetite in malnourished children

An innovative way to measure appetite levels in children may further clarify linkages between food intake levels and stunted/wasted growth and thus provide a strong leverage to future nutrition research.

Appetite is a psychological desire to eat - different from 'hunger' - the physical urge. Photo: GMB Akash

A simple interview-based measuring tool named Early Childhood Appetite and Satiety Tool (ECAST) was developed by icddr,b researchers to investigate levels of appetite – the psychological desire to eat – in children under five years by interviewing mothers and/or caregivers using a carefully crafted questionnaire.

“Data on impaired growth and its links to different nutritional and environmental factors are widely reported across the world but very little is known as to how appetite may be connected to impaired growth,” says Dr Tahmeed Ahmed, icddr,b senior director of nutrition and clinical services division and senior author of the study published in Appetite.

Researchers associated with University of Washington, CHAIN Network and Wheaton College co-authored the study with Dr Tahmeed, who was first to propose the idea of developing a tool to improve understanding of appetite levels and impaired growth.

Stunting is impaired growth, mainly due to poor nutrition, of children too short for their age. A similar impairment is wasting – those too thin in comparison to their healthy counterparts.

Bangladesh is a high-burden country for stunting or impaired growth. Photo: Sumon Yusuf / icddr,b

The ECAST scores of wasted children with good appetite were higher than those with poor appetite.

“This finding corresponds with children’s blood hormone levels associated with appetite, indicating that the tool seems to work,” says Dr Baitun Nahar, icddr,b associate scientist and principal investigator of the study.

She explains that appetite (psychological desire to eat) is distinguished from hunger – the physical urge to eat, and satiety – the point when hunger or appetite is substantiated with food, leading to a ‘full’ feeling. “We have initially validated the tool to find that it works reasonably well, and look forward to cross-cultural validation to determine its suitability in other contexts.” she adds.

There are many tools to assess appetite in overweight or obese children in western country context.

This newly developed and validated tool is especially designed to measure the appetite status of malnourished children, particularly the toddlers from low and middle income countries like Bangladesh, mentions Dr Muttaquina Hossain, icddr,b assistant scientist and co-author of the paper.

Many mothers struggle with feeding while children suffer from malnutrition. Photo: Shehzad Noorani / icddr,b

Misperception of appetite is a barrier to appropriate nutritional intervention, particularly for stunting. Initially icddr,b researchers have been curious to assess mothers’ perceptions of children's appetite to inform strategies to improve responsive feeding and tool development, according to findings in FASEB journal.

Findings published in Public Health Nutrition has also shown that community norms instead of nutritional programming or health systems guidance may influence caregivers in assuming how tall children are in comparison to their peers and siblings.

The tool emerging from these efforts is ECAST, which is expected to systematically approach investigation into feeding practices, levels of appetite and appropriate nutritional intervention. Researchers expect it to help evaluate appetite level in growth impaired children in the South Asian context, especially Bangladesh, also a high-burden country for stunting.

MN