Bulletin of the World Health Organization

New Delhi and New York children grow equally well

18 March 2002

Growth performance in children in south Delhi, India, is about the same as in high-income industrialized countries, a new study reports. Researchers at the All India Institute of Medical Sciences and the World Health Organization (WHO) found that the key factors in children’s physical development were parental education and adequate diet. These were strongly associated with higher length for age, whereas wealth on its own may account only for higher weight for age.

Reporting their findings in this month’s Bulletin of the World Health Organization (http://www.who.int/bulletin), Dr Nita Bhandari and colleagues conclude that "The children belonging to the subpopulation of affluent families residing in south Delhi with high parental education (i.e. at least one parent with 17 years or more of education) appear to have achieved their genetic growth potential."

The survey team, consisting of a physician, a nutritionist and two anthropometrists, worked in randomly selected neighbourhoods in the southern part of the city, consisting of bungalows with gardens, and apartment blocks. Exclusion criteria were the same as in the studies used for the 1977 US National Center for Health Statistics (NCHS) growth charts: children with under 37 weeks of gestation, or with chronic illnesses known to affect growth adversely. The families of 395 children aged 12–23 months participated in the study, which involved measuring the children’s weights and lengths, taking the heights of their mothers, and grandmothers where available, and collecting information on the parents’ education, occupations, income, assets, birth weight of the child, feeding practices, and health problems. The heights and weights of the children were comparable to those of the NCHS reference, but the heights of their mothers and grandmothers were lower. This appears to indicate an ongoing trend towards increased height in women.

The populations of some industrialized countries can be considered to have achieved their full genetic growth potential, whereas in developing countries this can only be said of certain affluent subpopulations. The children included in this study appear to belong to one such group, and the authors conclude that this population could conribute to the construction of a new growth reference for the world’s children. As a result of the study India was selected to participate in the WHO Multicentre Growth Reference Study aimed at constructing a new reference based on an international sample of breastfed infants in healthy populations without socioeconomic constraints on growth. The new growth curves that result should reflect the true potential of children’s growth achieved under desirable health and nutritional conditions.

"The WHO Multicentre Growth Reference Study is expected to provide a single international reference that represents the best description possible of optimal growth for all children up to five years of age. It will also establish the breastfed infant as the biological norm for growth and development", explained Dr Mercedes de Onis of WHO’s nutrition department. An important characteristic of the new reference is that it will be based on a truly international sample. Six countries, representing the world’s major geographical regions, are participating in the study: Brazil, Ghana, India, Norway, Oman and the USA. This will avert political difficulties that arise from using a single country’s child growth pattern as a worldwide "standard" for optimal growth.

For further information, contact Dr Mercedes de Onis, tel. (41 22) 791 33 20. Email deonism@who.int

Authors alone are responsible for views expressed in the Bulletin's signed articles, which are not necessarily those of the World Health Organization.

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