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When does growth faltering start?
J A Kusin1, S Kardjati, C de With
1Royal Tropical Institute, Amsterdam, The Netherlands.
Insights
Growth faltering in Madurese infants is best identified by analyzing weight increments, not just weight-for-age. This method helps pinpoint the critical 3-4 month period for intervention.
Area of Science:
- Pediatrics
- Human Growth and Development
- Nutritional Epidemiology
Background:
- Assessing infant growth faltering is crucial for early intervention.
- Traditional indicators like weight-for-age may be less sensitive in diverse populations.
- Understanding growth patterns in specific ethnic groups, like Madurese infants, is important.
Purpose of the Study:
- To evaluate different indicators for identifying the onset of growth faltering in Madurese infants.
- To determine the most effective method for pinpointing the age at which growth becomes unacceptable.
- To inform public health strategies for monitoring infant growth in Indonesia.
Main Methods:
- Compared three indicators: weight-for-age (NCHS/Cambridge references) and 4-week weight/length increments.
- Analyzed data from 391 singleton infants in Madura (1982-1984) with 4-weekly measurements.
- Defined faltering based on weight increments < -2 SD (Waterlow) or no length gain, using a 20% falterer cut-off.
Main Results:
- Weight-for-age indicators were less effective due to high variability and skewed distributions in Madurese infants.
- Analysis of weight increments identified the onset of growth faltering at or before 3-4 months.
- A 20% threshold for weight falterers was used to define the onset period.
Conclusions:
- Weight increment analysis is superior to weight-for-age for detecting growth faltering in this population.
- Growth monitoring data from POSYANDUS (Integrated Health Posts) should be analyzed for weight increments.
- This approach can map age periods at risk for growth faltering across Indonesia.
Abstract:
Three indicators were used to assess the onset of growth faltering: (a) average weight - and length - for - age as percentage of the NCHS references or (b) the Cambridge references based on breastfed infants and (c) incremental growth over 4 weeks in which "faltering" was defined as a weight increment less than minus 2 standard deviations, calculated by Waterlow from USA and British data or no gain in length. The population covered were singleton infants born in two villages in Madura in September 1982 through December 1984 (N = 391). Weight and length were measured at 4 week intervals. The first two indicators did not properly identify the age period at which growth became unacceptable according to weight or length increments. This was mainly due to the large variation and the skewed distribution of weight and length of Madurese infants. Arbitrarily a magnitude of 20% weight falterers was used as a cut-off point for the onset of growth faltering. Among Madurese infants it would be at or before 3-4 months. It is recommended to analyse weight increments from data, generated by growth monitoring at POSYANDUS for mapping of the age period at risk throughout Indonesia.