The NCHS Reference and the Growth of Breast- and Bottle-Fed Infants

Manuscript received 28 October 1997. Initial reviews completed 5 January 1998. Revision accepted 23 March 1998.

Cesar G. Victora^*, , Saul S. Morris^*, , Fernando C. Barros^*, Mercedes de Onis^**, and Ray Yip

^* Departamento de Medicina Social, Universidade Federal de Pelotas, CP 464, 96001-970, Pelotas, RS, Brazil;  London School of Hygiene and Tropical Medicine, London, United Kingdom; ^** Nutrition Unit, World Health Organization, Geneva, Switzerland; and  UNICEF Office, Jakarta, Indonesia and Centers for Disease Control and Prevention, Atlanta, GA

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 breast-fed 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 infantshigher than NCHS in the early months but an apparent decline thereafter. The pattern for length gain was similar but less marked. Breast-fed infants showed more pronounced declines than those who were predominantly bottle-fed. These findings suggest that the infancy portion of the NCHS reference does not adequately reflect the growth of either breast-fed 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.

The Journal of Nutrition Vol. 128 No. 7 July 1998, pp. 1134-1138
Copyright ©1998 by the American Society for Nutritional Sciences

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