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Growth of breast-fed infants deviates from current reference data: a pooled analysis of US, Canadian, and European
K G Dewey1, J M Peerson, K H Brown
1University of California, Davis 95616-8669, USA.
Insights
New reference data for breast-fed infants are needed as current World Health Organization (WHO)/Centers for Disease Control and Prevention (CDC) growth charts do not fully reflect their growth patterns. Breast-fed infants show distinct growth trajectories compared to the existing references.
Area of Science:
- Pediatric Nutrition
- Growth Monitoring
- Infant Development
Background:
- Current infant growth charts, established by the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC), are widely used for monitoring infant development.
- These reference data may not accurately represent the growth patterns of exclusively breast-fed infants, potentially leading to misinterpretation of growth trajectories.
Purpose of the Study:
- To compare the growth patterns of a large cohort of breast-fed infants with the existing WHO/CDC reference data.
- To identify discrepancies in growth parameters (weight, length, head circumference) between breast-fed infants and the current references.
Main Methods:
- Pooled data from seven longitudinal studies involving 453 breast-fed infants from North America and Northern Europe.
- Compared infant weight, length, and head circumference against WHO/CDC reference data.
- Utilized repeated-measures analysis of variance to assess the impact of breast-feeding duration, introduction of solids, and use of other milks on growth patterns.
Main Results:
- Infants breast-fed for at least 12 months exhibited faster initial growth in the first two months, followed by slower growth from 3 to 12 months compared to WHO/CDC references.
- At 12 months, mean z scores for weight-for-age, length-for-age, and weight-for-length were below the WHO/CDC median, indicating slower growth in these parameters.
- Head circumference in breast-fed infants was consistently above the WHO/CDC median throughout the first year.
- Longer duration of breast-feeding correlated with a greater decline in weight-for-age and weight-for-length, but not length-for-age.
Conclusions:
- The findings indicate that current WHO/CDC growth charts may not adequately represent the typical growth of breast-fed infants.
- New reference data, specifically derived from breast-fed infants, are necessary to accurately reflect growth patterns consistent with WHO feeding recommendations.
- Revised growth charts would improve the appropriate assessment and interpretation of growth in breast-fed infants.
Objective:
To compare growth patterns of a large sample of breast-fed infants with the current World Health Organization (WHO)/Centers for Disease Control and Prevention (CDC) reference data.
Methods:
Data from seven longitudinal studies of infant growth in North America and northern Europe were pooled (n = 453 breast-fed infants). Weight, length and head circumference were compared with the WHO/CDC reference, and repeated-measures analysis of variance was used to examine associations between growth patterns and breast-feeding duration, age of introduction of solid foods, and use of other milks.
Results:
In comparison with WHO/CDC reference data, infants breast-fed for at least 12 months (n = 226) grew more rapidly in the first 2 months and less rapidly (particularly in weight) from 3 to 12 months; the mean z score at 12 months was -0.53 for weight for age, -0.29 for length for age, and -0.32 for weight for length. In contrast, mean head circumference was well above the WHO/CDC median throughout the first year of life. These patterns were generally consistent across studies. In the full sample (n = 453), a longer duration of breast-feeding was associated with a greater decline in weight for age and weight for length but not length for age.
Conclusion:
These results suggest that if growth charts are to reflect patterns consistent with those of infants following WHO feeding recommendations, new reference data based on breast-fed infants are needed.