After having read the article in the Int'l Journal of Epidemiology by
Padmadas, Hutter and Willekens, on 'Weaning initiation patterns and subsequent
linear growth progression among children aged 2-4 years in India, I am not at
all convinced that this study provides reason to change the WHO
recommendations for exclusive BF for 6 months.
The tables are very confusing, and the numbers provided in the article do not
make it possible for the reader to check the investigators' conclusions.
Weaning age is defined as the age when babies are given something other than
breastmilk (from the breast, in this study, expression is not mentioned) or
water.  It seems that all these children continued to be breastfed long, long
after the first weaning foods were introduced.
Stunting appears to be much more prevalent in areas with many other indicators
of poverty, such as lower female literacy and lower proportion of population
in contact with the health services.  I am too tired to try to figure out how
much of a confounder these factors are, and I am not sure it is even possible
from the data provided in the article.

Weight is not mentioned anywhere.  Not birthweight, not weight at time of
height measurements.  The height curves used are the same ones as in the US,
it seems.  There is no mention made of the infant mortality rate, in the
individual areas mentioned nor in India as a whole.

There are big differences between various regions.  Some of the regions are
represented with only a few dozen infants in each age category at time of
interview.  How these particular infants were selected, indeed how the entire
study population was selected, are not disclosed as far as I could tell.
From the figures it is evident that introduction of other foods before 3
months is associated with high proportions of stunting.  Then stunting goes
down for babies who get other foods introduced around 3 months, and rises
again after 6.

One other thing jumped out at me, because I can not remember seeing an
acknowledgment of this kind before: 'We gratefully acknowledge the editorial
remarks and invaluable comments and suggestions provided by two anonymous
reviewers.'  **Who** were they?  Curious, cynical minds want to know!

Rachel Myr
waiting for the school library to open tomorrow so I can go find the Lancet
article on asthma too...

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