I just read an article summarized in Medscape Pediatrics entitled, "Late
Initiation of Weaning Linked to Stunted Growth in Indian Children" by C.
Vidyashankar which was published in Int J Epidemiol 2002;31:855-863.   The
Medscape article can be found at
http://www.medscape.com/viewarticle/441196?mpid=3705 (you may need to
register but registration is free).

I was alarmed as I read this since the author writes that his data suggest
the WHO guidelines for 6 months of exclusive breastfeeding may need to be
re-examined in light of his findings.  I am hoping to gain access to the
original article somehow because I have many questions about the methodology
of this study.  Here is the Medscape summary:

Late Initiation of Weaning Linked to Stunted Growth in Indian Children

By C. Vidyashankar
DELHI (Reuters Health) Sept 06 - Initiation of weaning after 6 months of age
could be responsible for the high prevalence of stunted growth in young
Indian children, researchers report.

The time of introduction of foods is important in determining the growth in
early childhood because "breast milk alone is insufficient to meet their
full nutritional needs," Dr Sabu S Padmadas and colleagues from the
University of Groningen, The Netherlands, write in the August issue of the
International Journal of Epidemiology.

The researchers analyzed the data from the Indian National Family Health
Survey (NFHS), conducted from 1992 to 1993, to determine the relationship
between the timing of weaning and stunting in children aged 24 to 47 months.
Stunting was defined as height more than 2 standard deviations below the
median and weaning as the age at which complementary foods are introduced
and exclusive or predominant breastfeeding ends.

The NFHS 1992-1993 was a comprehensive survey that collected data from over
88,000 households and covered 25 Indian provinces. The investigators'
analysis was limited to 6,285 children whose anthropometric records were
available.

According to the survey findings, 52.0% of the children were stunted, and
weaning was initiated at or after 6 months of age in nearly half of the
children. Stunting was most prevalent in central, eastern and northern
India, while weaning was delayed in central India and parts of eastern
India, the researchers note.

The researchers observed that stunting was least common among children
weaned at 3 months of age and increased thereafter. Stunting showed an
upward trend for children weaned between 0 and 2 months, decreased sharply
at 3 months, but increased steadily afterwards, they write.

Nearly two-thirds of children weaned at 6 months were stunted, the
investigators report. The likelihood of stunting was 77% for children from
poor families who were weaned after 6 months and had not received all their
immunizations in the first year of life, they write.

"Our finding that weaning at age 6 months or after increases the risk of
stunting at later ages contrasts with the World Health Organization
recommendations that suggest exclusive breastfeeding till 6 months," Dr.
Padmadas told Reuters Health.

In the study, the types of weaning foods were not known, the researchers
write. However, "we believe that a revision of WHO breastfeeding policy
might be required, particularly for India, where poverty and malnutrition
[of mothers and children] continue to remain high," Dr. Padmadas concluded.

Int J Epidemiol 2002;31:855-863.


Sara Furr
LLLL in Nebraska

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