Early Life Nutrition and Lifelong Health - Derbyshire Local Medical ...

BMA Board of Sciencethe mothers were willing to breastfeed exclusively for at least four months continuing until12 months, and to introduce complementary feeds by six months; and none were smokers. Thedata were collected using standardised techniques in the USA, Oman, Norway, Brazil, Ghana andIndia in 1997-2003. One concern about the generalisability of these standards is the wideinternational variation in birth weight. Mean maternal height and birth weight in Oman and Indiawere much lower than in Norway and the USA, indicating maternal constraint on fetal growth inthese developing countries, which is also likely to be associated with effects on postnatal growth,inducing more rapid catch-up growth. 172Box 9: Comment on the WHO infant growth reference standard‘The most interesting thing about the study that gave rise to these standards is that despitebeing based on very diverse populations around the globe, they produced very similar growthcurves, indicating that genetics plays a very small part in determining growth rates comparedwith environmental factors which were optimised for this study – healthy pregnancy, goodmother and child nutrition, no smoking, full breastfeeding etc.’Tim Lobstein, Director Childhood Obesity Research ProgrammeA joint expert group from SACN and the Royal College of Paediatrics and Child Heath (RCPCH)met to consider the routine use of the WHO standards in the UK. 172 They concluded that UKinfants would appear large at birth and show apparent marked catch-down growth during the firstfew weeks, which could discourage mothers from breastfeeding. Using the WHO standards would,however, reduce the number of UK infants showing weight faltering, and thus being classified asunderweight, after four months. They found little difference in length between the UK 1990 andWHO references at any age, and there was convergence of weight in the two references fromaround two years onwards. The group advised adoption of the WHO Growth Standard for routineuse from two weeks to 24 months, while retaining the UK 1990 reference from 24 monthsonwards. Since the WHO reference population did not include pre-term infants, the UK 1990reference would also need to be retained for these infants. They recommended piloting of the newcharts, training for health professionals, and a well-planned communications strategy precedingimplementation. It is not clear when all this will happen, but it is unlikely that the standard will bein general use before 2009.Key messageInfant growth-charts currently in general use in the UK (based on 1990 UK reference data) arenow considered inadequate because weight gain patterns of breastfed infants deviateconsiderably from such data. Old growth charts should be replaced by the 2006 WHO newgrowth reference – based exclusively on breastfed babies – for assessing all infants agedbetween two weeks and 24 months.Early life nutrition and lifelong health 39