FOR RELEASE: July 9, 1997
Contact: Susan Lang
Office: (607) 255-3613
Internet: [email protected]
Compuserve: Larry Bernard 72650,565
http://www.news.cornell.edu
ITHACA, N.Y. -- Millions of healthy infants may be assessed as growing too
slowly because of inadequate international child growth standards,
according to nutritionists from Cornell University and the World Health
Organization (WHO). As a result, many infants are taken off breast milk
and given solid foods before they need them, with potentially
life-threatening consequences.
In fact, child growth standards -- the set of height and weight guidelines
health workers use to assess whether growth is occurring at satisfactory
rates for good health -- are inadequate for many young children, not just
infants, Cornell experts say.
"Although current growth references for young children have served many
useful purposes, we have come to recognize that they have a number of
serious drawbacks and are not suitable for healthy, breast-fed infants
around the world whose caregivers follow health recommendations," said
Cutberto Garza, M.D., chair of the WHO Working Group on Infant Growth.
Garza is director of the Division of Nutritional Sciences at Cornell and
associate director of the Food and Nutrition Programme for Human and Social
Development at United Nations University. Garza also is a member of the
WHO Expert Committee established to reevaluate the use of growth standards
for different ages.
"We now know that health workers, using the current references, too easily
make faulty decisions regarding the adequate growth of breast-fed infants
and thus mistakenly advise mothers to supplement unnecessarily or to stop
breast-feeding altogether. Given the health and nutritional benefits of
breast-feeding, which include helping to prevent severe infectious and
potentially fatal diseases, this potential misinterpretation of the growth
pattern can have dire results," he said.
For more than five years, two WHO Working Groups on Infant Growth, under
Garza's direction, have been analyzing and assessing the current growth
references, which were established by the National Center for Health
Statistics (NCHS) and recommended by the WHO since the late 1970s. Those
growth curves were based on two sets of data, both using samples of
American children.
"We found early on that infants who live under favorable conditions and are
fed according to the WHO feeding recommendations often grow more slowly
than the patterns reflected in the NCHS-WHO international reference," Garza
said. "Yet, there are serious dangers of both introducing solid foods too
early and, in other cases, of delaying them. The Working Group concluded
that the current growth references only accentuate the difficulty of
avoiding these extremes rather than helping ensure optimal infant
nutritional management."
The Working Group, which also included Cornell statistician Edward
Frongillo, authored both a 1994 WHO monograph, An Evaluation of Infant
Growth, that details the group's analyses and justification for new
references and a 1995 paper in the Bulletin of the World Health
Organization on the use and interpretation of those growth standards in
infants.
Garza and Cornell colleagues Jean-Pierre Habicht, the James Jamison
Professor of Nutritional Epidemiology, and Jere Haas, the Nancy Schlegel
Meinig Professor of Maternal and Child Nutrition, also served as members of
the WHO Expert Committee that was charged with re-evaluating the use of
growth standards for different ages for assessing health, nutrition and
social well-being.
In a 1996 issue of the American Journal of Clinical Nutrition (Vol. 64, pp.
650-658), the committee spelled out which standards were still appropriate
for each age group. It noted, again, that a new reference, though complex
and costly to establish, was needed for infants and children.
"The need for a new international growth reference is becoming a matter of
urgency," the committee wrote, "especially in underprivileged populations
in whom the optimal nutritional management of infants and young children is
key to survival, or at least to preventing severe infections."
Speaking to the World Health Assembly in May and co-authoring an editorial
to be published in an upcoming issue of Pediatrics later this year, Garza
acknowledges that the construction of a new reference will be extremely
complex, costly and time-consuming.
Nevertheless, thanks to the work by investigators all over the world, the
WHO Multicentre Growth Reference Study is under way. It will be based on
an international sample of infants and children in at least seven sites
around the world who are fed by internationally recognized health
standards. Initiated in July in Pelotas, Brazil, by Dr. Cesar Victore, the
multicenter study should be completed with the new growth curves ready for
adoption by 2001.
"With the support of the international nutritional community --
governments, intergovernmental and nongovernmental organizations, research
institutions and health professionals worldwide with strong commitments to
infant and young child health -- the world will celebrate the arrival of
the next millennium with a technically and biologically sound growth
reference that will enhance the nutritional management of infants and young
children and thus support their improved survival and development," Garza
concluded.
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