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  • Title: [Growth of exclusively breast-fed Chilean infants in relation to new 1994 WHO Reference Charts].
    Author: Atalah Samur E, Castillo Lancelloti C.
    Journal: Arch Latinoam Nutr; 1997 Mar; 47(1):29-33. PubMed ID: 9429637.
    Abstract:
    The aim of this study was to evaluate the growth of Chilean infants from medium-to-low socioeconomic status fed according to the current WHO guidelines. Growth pattern was compared to a recent reference chart published by WHO for infants, and the NCHS/WHO growth standards. The source of information was a nation-wide infant feeding survey conducted in 1993. From this database, infants aged 1-12 month +/- 5 days, with exclusive breast feeding until the fourth or sixth month were selected (939 males, 940 females). The weight-for-age z-score (WAZ), and the height-for-age z-score (HAZ) were calculated using both the NCHS/ WHO and the new WHO reference growth charts. At each month of age, WHZ and HAZ results were grouped in the following categories: < = -2.0; -1.9 to -1.0; 0 +/- 0.9; 1.0 to 1.9; and > = 2.0. Observed WAZ at the first month of age was below the new WHO reference chart (0.32 z-score), increasing up to 1.29 z-score at the tenth month. The HAZ results were lower the WHO reference chart throughout the period studied, although a trend to improved values was noted during the second semester (F = 6.01 p < 0.001). Growth pattern of the studied group was more similar to the NCHS/WHO chart than the new chart proposed by WHO. As a consequence, the new WHO reference chart identifies a higher proportion of the infants as having a subnormal nutritional status during the first semester of life, compared to those classified in this category by the NCHS/WHO standards (p < 0.001). This can be a factor for the introduction of complementary foods early in life. The relative homogeneity of the population used as source of the WHO reference chart may limit it use in developing countries. Growth data from Chile's 1993 National Breast Feeding Survey of infants under 1 year old fed according the World Health Organization (WHO) recommendations were compared to recent reference standards for breast-fed infants published by WHO and to National Center for Health Statistics (NCHS)/WHO growth standards. WHO recommendations call for exclusive breast feeding for the first several months, with solid food introduced at 4-6 months. The Chilean sample included 939 boys and 940 girls. The z-scores for weight-for-age and height-for-age were calculated using both the NCHS/WHO and the new WHO growth charts. The weight-for-age z scores were below the new WHO norms by the 1st month of age, but later increased to 1.29 by the 10th month. Average height-for-age was below the new norm for the entire period studied, despite improved values noted in the second half of the 1st year of life. The observed pattern of growth was more similar to the old NCHS/WHO reference chart than to the proposed new WHO chart. The new WHO chart consequently identifies a higher proportion of breast-fed infants as showing nutritional deficits, which could contribute to premature introduction of supplemental feeding. The new WHO reference chart was based on observations of 226 infants in the US, Canada, Denmark, Sweden, Finland, and the UK who were exclusively breast fed for at least 4 months. The relative homogeneity of the population used as the source of the proposed WHO reference chart may make it inappropriate for use in developing countries.
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