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.
PIP: The National Center for Health Statistics (NCHS) reference is the international standard widely used to compare the nutritional status of populations and to assess the growth of individual children around the world. There has, however, recently been concern over the adequacy of this reference for assessing the growth of breast-fed infants. Findings are presented from an evaluation of infant growth using the NCHS reference in the city of Pelotas, Brazil, one of the most developed areas of the country. The 5304 children enrolled in the study comprised all but 0.3% of all hospital births occurring in the city in 1993. Infants who were either exclusively or mainly breast-fed for the first 4-6 months, and partially breast-fed thereafter, grew faster than the NCHS reference in weight and length during the first 3 months, but appeared to falter thereafter. The average growth of all infants, regardless of feeding pattern, was faster than the NCHS reference until approximately age 6 months, after which they grew slower than did the NCHS sample. A comparison of NCHS growth curves with growth data on breast-fed infants in developed countries from pooled published studies, formula-fed North American and European infants, and mainly bottle-fed US infants monitored by the Centers for Disease Control and Prevention (CDC) Pediatric Surveillance System found infant weights in all cases to exhibit the same pattern as that of the Brazilian infants. The pattern for length gain was similar, but less marked. Breast-fed infants showed more pronounced declines than those who were mainly bottle-fed. An improved international growth reference should be developed and used.