Growth of Indonesian Infants Compared With World Health Organization Growth Standards

Pramita G Dwipoerwantoro, Muchtaruddin Mansyur, Hanifah Oswari, Maria Makrides, Geoffrey Cleghorn, Agus Firmansyah, Pramita G Dwipoerwantoro, Muchtaruddin Mansyur, Hanifah Oswari, Maria Makrides, Geoffrey Cleghorn, Agus Firmansyah

Abstract

Objectives: The ability of the World Health Organization (WHO) growth standards to represent the growth of South East Asian infants has been questioned. The aim of this study was to provide contemporary data on the growth of Indonesian breast-fed and formula-fed infants, compared with the WHO growth standards.

Methods: A prospective cohort study of 160 normal healthy infants was undertaken in a suburban area of South Jakarta, Indonesia. Infants from 2 to 6 weeks of age were recruited, and they consumed exclusively either breast milk or infant formula for at least 6 months, with follow-up until 12 months of age.

Results: Overall, the infants in the present study were lighter (weight-for-age), were shorter (length-for-age), and had smaller head circumferences (head circumference-for-age) than the average WHO Growth Reference Study population but were of similar proportion (weight-for-length). Compared with the WHO Growth Reference Study, the z scores for weight-for-age, length-for-age, and head circumference-for-age in the Indonesian children fell from birth to 6 weeks of age and then increased until 3 months of age in both the breast-fed and the formula-fed infants. At 6 weeks of age, the weight-for-age z scores fell below -2 standard deviations for 16 (20.5%) breast-fed and 40 (51.3%) formula-fed infants, and the length-for-age z scores fell below -2 standard deviations for 31 (39.7%) breast-fed and 41 (52.6%) formula-fed infants.

Conclusion: The WHO growth standards do not reflect the growth of the present cohort of Indonesian infants and may overestimate the levels of underweight and stunted children.

Trial registration: ClinicalTrials.gov NCT01721512.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
World Health Organization growth standard z scores for breast-fed and formula-fed infants. Results are least squares means and 95% confidence intervals. ∗P < 0.05, ∗∗P < 0.01, ∗∗∗P < 0.001; -♦- breast-fed, □ formula-fed.

References

    1. World Health Organization. WHO Multicentre Growth Reference Study Group: WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Geneva: World Health Organization; 2006.
    1. de Onis M, Onyango A, Borghi E, et al. Worldwide implementation of the WHO child growth standards. Public Health Nutr 2012; 15:1603–1610.
    1. de Onis M, Garza C, Victora CG, et al. The WHO multicentre growth reference study (MGRS): planning, study design, and methodology. Food Nutr Bull 2004; 25:S15–S26.
    1. Ziegler EE, Nelson SE. The WHO growth standards: strengths and limitations. Curr Opin Clin Nutr Metab Care 2012; 15:298–302.
    1. Hui LL, Schooling CM, Cowling BJ, et al. Are universal standards for optimal infant growth appropriate? Evidence from a Hong Kong Chinese birth cohort. Arch Dis Child 2008; 93:561–565.
    1. Tanaka H, Ishii H, Yamada T, et al. Growth of Japanese breastfed infants compared to national references and World Health Organization growth standards. Acta Paediatr 2013; 102:739–743.
    1. Oswari H, Prayitno L, Dwipoerwantoro PG, et al. Comparison of stool microbiota compositions, stool alpha1-antitrypsin and calprotectin concentrations, and diarrhoeal morbidity of Indonesian infants fed breast milk or probiotic/prebiotic-supplemented formula. J Paediatr Child Health 2013; 49:1032–1039.
    1. Squires J, Bricker D, Potter L. Revision of a parent-completed development screening tool: ages and stages questionnaires. J Pediatr Psychol 1997; 22:313–328.
    1. Binns C, James J, Lee MK. Why the new WHO growth charts are dangerous to breastfeeding. Breastfeed Rev 2008; 16:5–7.
    1. Cattaneo A, Guoth-Gumberger M. The new WHO child growth standards: possible effects on exclusive breastfeeding in the first six months. Breastfeed Rev 2008; 16:9–12.
    1. de Onis M, Blössner M, Borghi E, et al. WHO Global Database on Child Growth and Malnutrition. Geneva: World Health Organization; 2003.
    1. Kerac M, Blencowe H, Grijalva-Eternod C, et al. Prevalence of wasting among under 6-month-old infants in developing countries and implications of new case definitions using WHO growth standards: a secondary data analysis. Arch Dis Child 2011; 96:1008–1013.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel