Victora C G, Morris S S, Barros F C, de Onis M, Yip R
Departamento de Medicina Social, Universidade Federal de Pelotas, CP 464, 96001-970, Pelotas, RS, Brazil.
J Nutr. 1998 Jul;128(7):1134-8. doi: 10.1093/jn/128.7.1134.
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 approximately 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. 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.
当前国际生长参考标准，即美国国家卫生统计中心（NCHS）参考标准，被广泛用于比较不同人群的营养状况以及评估世界各地儿童个体的生长情况。最近，有人对该参考标准在评估母乳喂养婴儿生长方面的适用性提出了担忧。我们使用NCHS参考标准来评估巴西最发达地区之一的婴儿生长情况。在出生后的前4至6个月纯母乳喂养或主要母乳喂养、之后部分母乳喂养的婴儿，在出生后的前3个月体重和身长的增长速度比NCHS参考标准更快，但此后似乎生长变缓。无论喂养方式如何，所有婴儿的平均生长速度在大约6个月前都比NCHS参考标准快，之后其生长速度变得比NCHS样本慢。为证实这一发现，随后将NCHS生长曲线与已发表的汇总研究中发达国家母乳喂养婴儿的生长数据、北美和欧洲配方奶喂养婴儿以及由疾病控制与预防中心（CDC）儿科监测系统监测的美国主要奶瓶喂养婴儿的生长数据进行了比较。在所有这三种情况下，体重呈现出与巴西婴儿相同的模式——在最初几个月高于NCHS标准，但此后明显下降。身长增长模式相似但不太明显。母乳喂养婴儿的下降比主要奶瓶喂养婴儿更明显。这些发现表明，NCHS参考标准的婴儿期部分不能充分反映母乳喂养或人工喂养婴儿的生长情况。这可能是由于原始样本的特征以及曲线拟合程序不完善所致。因此，需要制定一个能反映正常婴儿生长模式的改进后的国际生长参考标准。
