The NCHS reference and the growth of breast- and bottle-fed infants.
Victora CG, Morris SS, Barros FC, de Onis M, Yip R.
Journal of Nutrition 1998;128:1134-1138 [en anglais].
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Résumé [en anglais]
The current international growth reference, the National Center for Health Statistics (NCHS) reference, is widely used to compare the nutritional status of populations and to assess the growth of individual children throughout the world. Recently, concerns were raised regarding the adequacy of this reference for assessing the growth of breast-fed infants.
We used the NCHS reference to evaluate infant growth in one of the most developed
areas of Brazil. Infants who were exclusively or predominantly breast-fed for the first 4–6 mo, and partially breastfed
thereafter, grew more rapidly than the NCHS reference in weight and length during the first 3 mo, but appeared
to falter thereafter. The average growth of all infants, regardless of feeding pattern, was faster than the NCHS
reference until ‚6 mo, after which their growth became slower than that of the NCHS sample. To substantiate
this finding, the NCHS growth curves were then compared with growth data of breast-fed infants in developed
countries from pooled published studies, formula-fed North American and European infants and predominantly
bottle-fed U.S. infants monitored by the Centers for Disease Control and Prevention (CDC) Pediatric Surveillance
System. In all three cases, weights showed the same pattern as the Brazilian infants—higher than NCHS in the
early months but an apparent decline thereafter. The pattern for length gain was similar but less marked. Breastfed
infants showed more pronounced declines than those who were predominantly bottle-fed.
suggest that the infancy portion of the NCHS reference does not adequately reflect the growth of either breastfed
or artificially fed infants. This probably results from characteristics of the original sample and from inadequate
curve-fitting procedures. The development of an improved international growth reference that reflects the normal
infant growth pattern is indicated.