WHO growth standards for infants and young children
WHO growth standards for infants and young children
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DOI：
10.1016/j.arcped.2008.10.010
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发表时间：
2009-01-01
影响因子：
1.8
通讯作者：
Rolland-Cachera, M. -F.
中科院分区：
文献类型：
--
作者：
de Onis, M.;Garza, C.;Rolland-Cachera, M. -F.
健康母乳喂养婴儿的生长模式在很大程度上偏离了NCHS/WHO的国际参考。特别是，这一参考是不充分的，因为它主要是基于配方奶粉喂养的婴儿，就像今天使用的大多数国家生长图表一样。1997年至2003年期间，世卫组织在不同地理区域的6个国家（巴西、加纳、印度、挪威、阿曼和美国）进行了多中心生长参考研究，目的是描述生活在良好卫生条件下的健康母乳喂养婴儿的生长情况。这项研究结合了882名婴儿从出生到24个月的纵向随访和6669名18-71个月的儿童的横截面组成部分。在纵向追踪研究中，母亲和新生儿在出生时被纳入，并在家中访问了共21。第1、2、4、6周给药1次，第2-12个月每月给药1次，第2年每2个月给药1次。研究人群生活在有利于增长的社会经济条件下。纵向分量的个体纳入标准是：没有已知的健康或环境对生长的限制，母亲愿意遵循MGRS喂养建议（即，至少4个月的纯母乳喂养或主要母乳喂养，在6个月大时开始补充食物，并继续母乳喂养至至少12个月大），产妇在分娩前后不吸烟，单胎分娩，没有重大发病率。未排除足月低出生体重儿。除了婴儿喂养实践之外，横截面部分的资格标准与纵向部分的资格标准相同。在研究的横截面部分中，参与者需要至少3个月的母乳喂养。为0-60个月的男孩和女孩生成体重饲料、年龄别身长/身高、身高别体重和年龄别体重指数百分位数和Z评分值。世卫组织网站（www.who.int/childgrowth/en）提供了全套表格和图表，以及便于应用的软件和培训材料等工具。世卫组织的儿童生长标准是根据那些在尽量减少不良饮食和感染等生长限制的环境中长大的儿童制定的。此外，他们的母亲遵循健康的做法，如母乳喂养孩子，怀孕期间和怀孕后不吸烟。这些标准描述了人类在最佳环境条件下的正常生长，可用于评估世界各地的儿童，无论其种族、社会经济地位和喂养类型如何。这些标准明确将母乳喂养确定为生物规范，并将母乳喂养的儿童确定为生长和发育的规范模式。它们有可能显着加强卫生政策和公众对母乳喂养的支持。来自6个参与国的汇总样本有助于制定一个真正的国际参照标准，该标准强调了这样一个事实，即当儿童的健康和护理需求得到满足时，世界各主要地区的儿童人口增长情况相似。它还提供了一个工具，及时和适当的民族多样性，在美洲和欧洲看到越来越多的多种族社会在世界其他地方的演变。世卫组织的标准为监测婴儿早期快速和不断变化的生长速度提供了一个更好的工具，它们还表明，世界各地在健康环境中长大并遵循推荐喂养方法的健康儿童具有惊人相似的生长模式。(C)2008年，Elsevier Masson SAS。All rights reserved.
The growth pattern of healthy breastfed infants deviates to a significant extent from the NCHS/WHO international reference. In particular, this reference is inadequate because it is based on predominantly formula-fed infants, as are most national growth charts in use today. The WHO multicentre growth reference study (MGRS), aimed at describing the growth of healthy breastfed infants living in good hygiene conditions, was conducted between 1997 and 2003 in 6 countries from diverse geographical regions: Brazil, Ghana, India, Norway, Oman and the United States. The study combined a longitudinal follow-up of 882 infants from birth to 24 months with a cross-sectional component of 6669 children aged 18-71 months. In tire longitudinal follow-up study, mothers and newborns were enrolled at birth and visited at home a total of 21. times at weeks 1, 2, 4 and 6; monthly from 2-12 months; and bimonthly in the 2nd year. The study populations lived in socioeconomic conditions favorable to growth. The individual inclusion criteria for the longitudinal component were: no known health or environmental constraints to growth, mothers willing to follow MGRS feeding recommendations (i.e., exclusive or predominant breastfeeding for at least 4 months, introduction of complementary foods by 6 months of age and continued breastfeeding to at least 12 months of age), no maternal smoking before and after delivery, single-term birth and absence of significant morbidity. Term low-birth-weight infants were not excluded. The eligibility criteria for the cross-sectional component were the same as those for the longitudinal component with the exception of infant feeding practices. A minimum of 3 months of any breastfeeding was required for participants in the study's cross-sectional component. Weight-forage, length/height-for-age, weight-for-length/height and body mass index-for-age percentile and Z-score values were generated for boys and girls aged 0-60 months. The full set of tables and charts is presented on the WHO website (www.who.int/childgrowth/en), together with tools such as software and training materials that facilitate their application. The WHO child growth standards were derived from children who were raised in environments that minimized constraints to growth, such as poor diets and infection. In addition, their mothers followed healthy practices such as breastfeeding their children and not smoking during and after pregnancy. The standards depict normal human growth under optimal environmental conditions and can be used to assess children everywhere, regardless of ethnicity, socioeconomic status and type of feeding. The standards explicitly identify breastfeeding as the biological norm and establish the breastfed child as the normative model for growth and development. They have the potential to significantly strengthen health policies and public Support for breastfeeding. The pooled sample from the 6 participating Countries allowed the development of a truly international reference that underscores the fact that child populations grow similarly across the world's major regions when their health and care needs are met. It also provides a tool that is timely and appropriate for the ethnic diversity seen within Countries and the evolution toward increasingly multiracial societies in the Americas and Europe as elsewhere in the world. The WHO standards provide a better tool to monitor the rapid and changing rate of growth in early infancy.They also demonstrate that healthy children from around the world who are raised in healthy environments and follow reommended feeding practices have strikingly similar patterns of growth. (C) 2008 Elsevier Masson SAS. All rights reserved.