Readers may find helpful an article by the WHO Working
Group on Infant Growth, one of whose members is Katherine
Dewey, printed in the Bulletin of the World Health
Organization 1995;73(2):165-174: An evaluation of infant
growth: the use and interpretation of anthropometry in
infants. <In reviewing the growth of infants who live under
favourable conditions and are fed according to WHO feeding
recommendations, the WG found significant differences
between the growth patterns of these infants and the
patterns reflected in the NCHS-WHO international reference.
Given the short- and long-term consequences of growth
failure, and the dangers of both the premature introduction
of complementary food and their undue delay--described as
the "weanling's dilemma"--the WG concluded that use of the
current WHO-NCHS reference appears to accentuate the
difficulty of avoiding these extremes rather than to help
ensure optimal infant nutritional management. <The WG
identified the following requirements: (a) a new reference
which will enhance the nutritional management of infants;
(b) the reference population should reflect current health
recommendations because of the frequent use of such
reference data as standards; (c) evaluation, in a broad
range of settings, of the practical utility of using
reference data based on infants for whom the WHO feeding
recommendations are being followed; (d) close investigation
of the effects of different complementary foods on the
growth of infants who are being fed according to the WHO
recommendations; (e) criteria for evaluating abnormal growth
patterns; (f) research for identifying proxy measures for
length; and (g) evaluation of reference data based on other
anthropometric measurements, such as skinfold thickness and
arm and head circumferences.> For information, the current
NCHS (National Center for Health Statistics, USA)-WHO
reference for infants is based on the Fels Longitudinal
Study, conducted in Yellow Springs, Ohio, from 1929 to 1975.
<There are several limitations in these reference data.
First, the sample was limited to Caucasian infants from
predominantly middle-class families. Second, the
measurements were taken every 3 months rather than every
month, which is not ideal for characterizing the shape of
the growth curve, particularly during the first 6 months of
life. Lastly, most of the infants in the Fels study were
bottle-fed; of those who were breast-fed, very few were
breast-fed for more than 3 months.>
Jim Akre, Nutrition unit, WHO, Geneva
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