I haven't checked the methods section of the WHO growth charts yet, but I have to say 
that there was never any evidence to support the notion that Asian babies grow any 
differently than babies anywhere else.  The ONLY population wide minor difference that 
was ever seen to persist and was unexplainable by nutrition was a 0.5 cm difference in 
height (I believe it was at age five) among South East Asians compared to other 
populations.  This was HEIGHT, not WEIGHT.  I think there was also a slight difference in 
chest circumference among Andian populations that didn't go away when they moved and 
grew up in low altitudes.  Not sure if this was thoroughly researched.  Thus, there is the 
notion that there may have been enough time for populations in the Andes to have 
undergone some real genetic adaptations to a larger chest to survive the lower oxygen 
levels.

If you go through the Lactnet archives, Kathy Dettwyler did a critique of the WHO chart 
methodology.  The gist that I remember, and she can correct my faulty memory if I got it 
wrong, was that the charts narrowed the weight range.  Infants who were ill were not in 
the group.  The groups contained infants from places like UC Davis where sleep training 
and scheduled feedings may have tinkered with the top end of the spectrum of potential 
growth.

LONG BEFORE the WHO growth charts it was a well known unofficially accepted idea that 
breastfed babies typically grew better in weight initially and then slowed faster among 
the nutrition graduate students at Cornell.  We factored that into our interpretations. So, 
the WHO growth charts fit my preconceived notions of normally growing breastfed 
infants.

If growth is used properly as an indicator -- the actual lines are not all that important.  
Even the old charts could be used appropriately to explore the feeding patterns and 
evaluation interventions and not used to DIAGNOSE.  The key word is to EXPLORE the 
factors influencing feeding and see if something is out of balance. 

The amount of work and dollars needed to construct growth charts is high.  These are 
multicountry studies over a long period of time with sophisticated techniques needed to 
deal with longitudinal data.  I think anytime someone feels research needs to be 
improved, we should be writing to our politicians or donating money to research on infant 
feeding.  

Best, Susan Burger

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