Seasonal variations and trends in weight and arm circumference of non-pregnant rural Senegalese women, 1990-1997.

OBJECTIVE: To describe levels, monthly variations and trends in weight and arm circumference of non-pregnant lactating women living in the Sahel, characterized by one short yearly rainy season (July-October). METHODS: A mixed unbalanced cross-sectional longitudinal observational study conducted at 3, 5, 7 and 10 months postpartum among 3869 women living in the Sine area in central Senegal who had brought their infants into dispensaries for immunization from January 1990 to February 1997, and 1-5 consecutive children per woman (26 106 visits). RESULTS: Mean weight was 55.7 kg (s.d.: 7.1), but it varied by 2.5-3.9 kg each year, from high means during the dry season (March-May) to low means at the end of the rainy season (September-November). The prevalence of underweight, overweight and obesity (body mass index (BMI)<18.5, 25-29.9 and >30 kg/m(2), respectively) was 7.6% (95% confidence interval: 7.3, 7.9), 6.4% (6.1, 6.7) and 0.4% (0.3, 0.4), but varied strongly by season (P<0.0001 for all). Unlike weight, mean arm increased during the early rains, a peak season of agricultural work (+0.10 cm/month (s.d.: 0.6) from June to August vs -0.35 kg/month (s.d.: 1.1) for weight). BMI and arm circumference were positively associated with age (mean: 20.8 vs 22.2 kg/m(2) and 25.3 vs 27.4 cm, at 20-24 and 40-49 years, respectively, P<0.0001 for both). CONCLUSIONS: Season was a major determinant of the anthropometric status of rural African women. Negative energy balance reduced body weight from the onset of agricultural labour, while arm circumference increased during early rains, probably due to high physical activity.

Effects of administration of iron, iodine and simultaneous iron-plus-iodine on the thyroid hormone profile in iron-deficient adolescent Iranian girls.

OBJECTIVE: To investigate whether iron supplementation can improve thyroid hormone function in iron-deficient adolescent girls. DESIGN: A double-blind randomized intervention study. SETTING: The study was performed from 2002 through 2003 in the Islamic Republic of Iran. SUBJECTS: 103 iron-deficient non-anaemic girls who fulfilled all inclusion criteria were included, and 94 subjects successfully completed the study. INTERVENTIONS: Patients were randomly assigned to one of four groups and treated with a single oral dose of 190 mg iodine plus 300 mg ferrous sulphate 5 times/week (n=24), 300 mg ferrous sulphate 5 times/week (n=23), a single oral dose of 190 mg iodine (n=25), or a placebo (n=22) for 12 weeks. RESULTS: All groups were comparable at baseline. After the intervention, there was a significant increase in ferritin and transferrin saturation in the iron+iodine group (17.6 vs 8.7 microg/dl, and 18.8 vs 7.2%, respectively, P<0.001 for both) and in the iron group (P<0.001 for both). Urinary iodine doubled in the iron+iodine group and in the iodine group (P<0.001 for both). Thyroid indices tT4, tT3 and T3RU increased and reverse RT3 decreased in the iron+iodine group (10 vs 8.9 microg/dl, P< 0.001; 143 vs 138 microg/dl, P<0.05; 32.3 vs 28.4%, P<0.001 and 24.8 vs 44.2 ng/dl, P<0.001, respectively) and in the iron group. These two groups did not differ for any of the four indices, but both differed significantly from the iodine and placebo groups. CONCLUSIONS: Our results indicate that improvement of iron status was accompanied by an improvement in some indices of thyroid hormones. SPONSORSHIP: This study was supported by the Dean of Research Affairs of the Tehran University of Medical Sciences.

Early short-term infant food supplementation, maternal weight loss and duration of breast-feeding: a randomised controlled trial in rural Senegal.

OBJECTIVE: Early supplementation of breastfed infants may have consequences both for the mother and the child. We hypothesised that it would result in decreased maternal weight loss and in shorter durations of breastfeeding and birth intervals. DESIGN: Controlled randomised population-based trial. SETTING: Six villages in the Sine area of Senegal, West Africa. SUBJECTS: Healthy breastfed infants and their mothers, 68 controls and 66 supplemented infants at randomization. INTERVENTION: Supplementation with high-energy, nutrient dense food from 4 to 7 months of age, twice daily under supervision of field workers. Both controls and supplemented infants were free to eat other complementary foods. Maternal weight was measured monthly. Dates of breastfeeding cessation and of subsequent births were collected prospectively through weekly demographic surveillance, and were analysed using Cox's regression models and 'intent-to-supplement' approach. RESULTS: Mean maternal weight gain from 4 to 7 months postpartum tended to be greater in the supplemented group (+0.25 kg/months, 95% confidence interval (CI): -0.07, +0.57). Supplemented infants were breastfed for significantly longer durations than controls (medians: 24.9 and 23.7 months, respectively, P: 0.034). Their adjusted hazard ratio (HR) for breastfeeding cessation was 0.59 (95% CI: 0.40, 0.89). Their mothers had a lower risk of a new birth than mothers of controls (adjusted HR: 0.57, 95% CI: 0.36, 0.92). CONCLUSIONS: Early short-term infant supplementation tended to decrease maternal postpartum weight loss, but it increased, rather than shortened, the duration of breastfeeding and birth interval. SPONSORSHIP: This study was supported by a grant from the French Ministry of Research (Grant 92L0623).

Change in body water distribution index in infants who become stunted between 4 and 18 months of age.

OBJECTIVE: To evaluate body composition changes using bioelectrical impedance analysis and skinfold thickness measurements in infants from tropical areas who become stunted between 4-18 months of age. DESIGN AND MEASUREMENTS: Follow-up study. Extracellular water to total body water ratio index (length(2)/resistance at low to high frequency), peripheral fat (tricipital and subscapular skinfold thickness), and length-for-age index were studied at 4 and 18 months of age. SETTINGS: Low-income areas in four tropical regions (Congo, Senegal, Bolivia and New Caledonia). SUBJECTS: Infants were included in the analysis provided they were neither stunted nor wasted at 4 months. Two groups of infants were compared, those that were stunted at 18 months (n=61) or not (n=170). RESULTS: The extracellular water to total body water ratio index and the sum of skinfold thickness measurements were similar in the two groups at 4 months, and only the extracellular water to total body water ratio index was significantly different at 18 months. When no stunting appeared between 4 and 18 months, the change in the extracellular water to total body water ratio index was not linked with variations in length-for-age, and presented the expected pattern of variation in body water compartments. When stunting occurred, variation in length-for-age was related to significant changes in the extracellular water to total body water ratio index, the biggest increase in the proportion of extracellular water being found in the most stunted infants. Variations in the sum of the two skinfold thickness measurements presented the expected pattern for the 4-18 months growth and did not differ between the two groups. CONCLUSIONS: Multifrequency resistances suggested that stunting was associated with a lack of the expansion of the intracellular compartment that is expected during normal growth of cell mass, together with preserved fat mass. SPONSORSHIPS: Supported by grant 92L0623 from the French Ministry of Research, and by Institut de Recherche pour le Développement (IRD).

Children's height, health and appetite influence mothers' weaning decisions in rural Senegal.

BACKGROUND: In many developing countries, breastfed children have a lower nutritional status than those weaned from 12 months of age. Reverse causality, that is, earlier weaning of healthy and well-nourished children, is a possible explanation. METHODS: Maternal reasons for early and late weaning were investigated in a cohort of 485 rural Senegalese children using structured interviews during two rounds at the ages of 18--28 and 23--33 months, respectively. Length, weight and height were assessed, and dates of weaning were monitored. RESULTS: The mean duration of breastfeeding was 24.1 months (quartiles 21.9 and 26.3). Two-thirds of mothers of breastfed children under 2 stated that they would wean at the age of 2, while for breastfed children aged 2 years, a 'tall and strong' child was the most prevalent criterion. The main reasons for weaning prior to 2 years (N = 244) were that the child ate well from the family plate (60%), that the child was 'tall and strong' (46%) and maternal pregnancy (35%). The main reasons for weaning later than the age of 2 were: a 'little, weak' child (33%), food shortage (25%), illness of the child (24%) and refusal of family food (14%, N = 120). Children breastfed above the age of 2 because they were 'small and weak' had lower mean height-for-age and a greater prevalence of stunting than children breastfed late for other reasons (P < 0.0001). CONCLUSION: The habit of postponing weaning of stunted children very likely explains why breastfed children have lower height-for-age than weaned children in this setting.

Breast-feeding is associated with improved growth in length, but not weight, in rural Senegalese toddlers.

BACKGROUND: Prolonged breast-feeding is frequently associated with malnutrition in less-developed countries, even after adjustment for socioeconomic confounders. However, in rural Senegal, breast-feeding is prolonged when the child is stunted. OBJECTIVE: We aimed to test whether the lower height-for-age of children weaned late is explained by their height before weaning or whether prolonged breast-feeding is associated with impaired growth. DESIGN: A cohort of 443 Senegalese children recruited from dispensaries at 2 mo of age were visited in their homes at 6-mo intervals when they were approximately 1.5 to 3 y of age. Weight, length, arm circumference, and triceps skinfold thickness were measured. Six-month increments were analyzed in relation to breast-feeding (breast-fed compared with weaned children or breast-feeding duration), season, and maternal housing with use of multiple linear regression. RESULTS: The mean duration of breast-feeding was 24.1 mo (quartiles 1 and 3: 21.9 and 26.4). Height-for-age at the age of 3 y was negatively associated with age at weaning (P < 0.01), but this association disappeared after adjustment for height-for-age in infancy. Length increments were significantly greater in both the second and third years of life in children breast-fed for longer durations (P < 0.05) and tended to be greater in breast-fed than in weaned children in the second year of life (P = 0.05). In the third year of life, breast-fed children had greater length increments than did weaned children in the subgroup with poor housing (P for interaction < 0.05). Growth in weight did not differ significantly according to breast-feeding. CONCLUSION: Prolonged breast-feeding improved linear growth, and the negative relation between height-for-age and duration of breast-feeding was due to reverse causality.

Relationship between stunting in infancy and growth and fat distribution during adolescence in Senegalese girls.

OBJECTIVE: To study the long-term impact of stunting during infancy on maturation, growth and fat distribution in adolescence. DESIGN: A cohort of 406 Senegalese adolescent girls of rural origin underwent clinical and growth assessments every year from 1995 to 1999. SUBJECTS: Mean coverage rate was 82% at each round. Adolescent girls were 11.4+/-0.5 y of age in 1995 and 15.5+/-0.5 y of age in 1999. Their growth status during infancy was known. About 20% of the girls had a height-age (H-age) below -2 Z-scores (chronic malnutrition or stunting) when they were 6-18 months of age. As adolescents, the girls were divided into two groups on the basis of H-age: those stunted and those non-stunted during infancy. MEASUREMENTS: Sexual maturation was assessed by stage of breast development and menarche. Height, body mass, sitting height, bi-iliac and bi-acromial diameters, and six skinfolds were measured. RESULTS: Differences in sexual maturation between previously stunted and non-stunted girls were not significant. Girls stunted at infancy caught up in body weight and subcutaneous fat mass during puberty, but they did not catch up on stature, sitting height or skeletal breadths (bi-acromial and bi-iliac diameters) until the final observation in 1999. Stunted girls did not have less subcutaneous fat (sum of six skinfolds) or a lower BMI. Regional variation in subcutaneous fat distribution (Z-score profile) indicated greater accretion at the biceps and subscapular sites in stunted compared to the non-stunted girls. Regional fat distribution was also assessed by principal component analysis (PCA) performed on the residuals of the six skinfolds measured during the final round (1999). PCA identified three components. Stunted and non-stunted girls were similar for the first (trunk-extremity contrast) and second (anterior-posterior contrast) components. However, there was a difference for the third component: stunted girls tended to accumulate more subcutaneous fat on the upper part of the body (trunk or arms) than non-stunted girls. CONCLUSION: Stunted Senegalese girls have a potential for catching up in growth during puberty. The greater accumulation of subcutaneous fat on the upper body in stunted girls may be a consequence of complex hormonal adjustments at the onset of puberty.

Mothers prolong breastfeeding of undernourished children in rural Senegal.

BACKGROUND: Breastfeeding, when prolonged beyond infancy, is a risk factor for low nutritional status in most cross-sectional samples from less developed countries. Therefore, it has been suggested that prolonged breastfeeding impairs growth. To test whether, on the contrary, breastfeeding is prolonged because the child is already undernourished, nutritional status prior to weaning was compared according to age at weaning. METHODS: Precise dates of birth and weaning were collected weekly through continuous demographic surveillance in a rural area of Senegal. Weight and length at 9-10 months were measured during vaccination sessions (coverage: 78%) from 1989 to 1996. Eight infants weaned before 9 months were excluded, and the duration of breastfeeding of the remaining 4515 children was compared according to nutritional status at 9-10 months by survival analysis. RESULTS: Length-for-age during infancy was associated with duration of breastfeeding: the median duration was 25.0 months for z-scores <-2, 24.1 months for z-scores -2 to -1, 23.4 months for z-scores -1 to 0 and 22.7 months for z-scores >0 (P for trend <0.0001). Weight-for-length during infancy was also associated with duration of breastfeeding (P for trend <0.0001), though the differences among groups were smaller. The relationships remained at the same significance levels after adjustment for season of birth, mother's age, parity, height, occupation and education. CONCLUSION: Duration of breastfeeding is not determined by characteristics of the mothers only. Women prolong breastfeeding for undernourished children and reduce the duration for well-nourished children, probably because they are aware of the mortality risk following weaning.

PIP: Several cross-sectional studies conducted in developing countries have indicated that prolonged breast feeding has a detrimental effect on child growth. It is possible, however, that breast feeding is prolonged in an attempt to correct undernutrition. This possibility was assessed through reference to demographic surveillance data on 4515 infants conducted in rural Senegal in 1989-96. Weaning data were collected weekly and weight and length were measured during vaccination sessions at 9-10 months of age. The prevalences of stunting and wasting were 13.7% and 11.6%, respectively. The median duration of breast feeding was 25.0 months for length-for-age z-scores less than -2, 24.1 months for z-scores from -1 to 0, and 22.7 months for z-scores above 0 (p 0.0001). At 24 months, the probability of still being breast-fed was 70.7% for children with a length-for-age of less than -2 z-scores and 37.5% for those who had a length-for-age above 0 z-score. Weight-for-length was also significantly associated with breast-feeding duration, although the differences among groups were smaller. These associations retained significance after adjustment for season of birth, parity, and maternal age, height, occupation, and education. These findings suggest that mothers do tend to prolong breast feeding for undernourished children and reduce its duration for well-nourished infants. The lower nutritional status often reported among breast-fed infants is probably not due to any negative impact of prolonged breast feeding on growth, but rather to pre-existing differences.

Preschool stunting, age at menarche and adolescent height: a longitudinal study in rural Senegal.

OBJECTIVE: To study the impact of preschool stunting on adolescent height and age at menarche in rural West Africa. DESIGN: A longitudinal, population-based study. SETTING: The Niakhar study area in Central Senegal. SUBJECTS: 1650 children aged 12-17 y with known height-for-age at the age of 2-5 y. MAIN OUTCOME MEASURES: Adolescent height; mean age at menarche of girls estimated by the status quo method. RESULTS: The subjects were divided into three groups of preschool height-for-age: < -2, -2 to -1 and > -1 z-score of the NCHS reference. The mean height during adolescence differed significantly according to preschool height-for-age for both boys and girls (P < 0.001). Relative risk of adolescent stunting according to preschool stunting varied from 2.0-4.0 depending on age and sex. Estimated mean age at menarche was 17.2 (95% fiducial confidence interval: 16.6-18.7), 16.5 (16.1-17.2) and 15.6 (15.2-16.0) y, respectively, for the three groups of preschool height-for-age (P < 0.001). Mean increment from age 5 y to adolescence did not differ significantly among the boys according to preschool stunting, but among the girls aged 16-17 y, the increment was higher for those who had been stunted during preschool life (P < 0.01). CONCLUSION: Some evidence of catch-up growth between the ages of 5 and 17 y was found for stunted girls. The significant delay in sexual maturation of the stunted girls suggests that stunted children of both sexes have a possibility of catch-up growth after the age of 17 y.

Nutritional status and age at menarche of Senegalese adolescents.

Growth and maturation during adolescence has not been well described in rural African populations, although it may represent the missing link between high levels of preschool stunting and nearly 'normal' adult heights. In 1995 the homes of subjects aged 10.3-17.5 years, living in a rural area of Senegal, were visited, and all adolescents present, 1527 boys and 1126 girls, were included in the analysis. A number of girls were absent because they worked in the capital city Dakar. Resident girls (n = 705) had significantly higher means than boys for all anthropometric variables (weight, body mass index, arm circumference and muscle arm circumference, triceps and subscapular skinfolds), except for height and head circumference. Girls who had just returned from seasonal migration to Dakar (n = 415) were, on average, 2 kg heavier, but not taller, than resident girls (p < 0.0001). The girls fell off in height from 11 to 13 years compared to the NCHS reference and then 'caught up' until the age of 17, while boys fell off during the entire age span. Mean age at menarche was estimated at 16.1 years (95% fiducial CI: 15.8-16.4) from status quo data by probit analysis. No significant difference was found between residents and migrants. Postmenarcheal girls had better nutritional status than premenarcheal girls in terms of height, weight, body mass index, percentage body fat and arm muscle circumference (p < 0.0001). In conclusion, puberty, as assessed by age at menarche, is delayed by about 3 years in this population, probably due to malnutrition.

Age at introduction of complementary food and physical growth from 2 to 9 months in rural Senegal.

OBJECTIVE: To compare nutritional status and physical growth among infants according to age at introduction of complementary food (CF). DESIGN: A longitudinal observational study. SETTING: Three health clinics in a rural area of Senegal. SUBJECTS: During immunization sessions, 522 infants were recruited at 2-3 months. Complete data on three visits were available for 420 infants (4 visits: n = 361); 73 were lost to follow-up and 29 had incomplete data. MAIN OUTCOME MEASURES: Increments in length and weight between adjacent visits. RESULTS: Infants complemented at 2-3 months (n = 50) had significantly lower length-for-age (P = 0.014), weight-for-length (P < 0.001) and arm circumference (P < 0.0001) at 2-3 months than predominantly breastfed infants (n = 370), after adjustment for residence, mother's age and education of parents. The growth in weight and length from 2-3 to 9-10 months did not differ. The infants complemented by 4-5 months, but not yet at 2-3 months, (n = 94) had a slightly lower length increment from 4-5 to 6-7 months (1.42 vs 1.53 cm/mo, p < 0.05) compared to infants predominantly breastfed at 4-5 months (n = 276). The infants first complemented by 6-7 months (n = 122) had increments from 6-7 to 9-10 months similar to those of predominantly breastfed infants (n = 154). CONCLUSION: Introduction of CF by 2-3 months was associated with a low nutritional status, but not with slow growth from 2-3 to 9-10 months. Introduction of CF by 4-5 months was associated with slightly slower linear growth compared to later introduction.

PIP: The impact of age at introduction of supplementary foods on nutritional status and physical growth was investigated in a longitudinal study of 420 infants recruited from 3 health clinics in rural Central Senegal. Infants were 2-3 months of age at admission and were followed up at 4-5, 6-7, and 9-10 months of age. The 50 infants who were receiving supplementary feeds at 2-3 months had significantly lower length-for-age, weight-for-length, and arm circumference at the initial visit than predominantly breast-fed infants after adjustments for residence, maternal age, and parental education. The 94 infants who began receiving complementary feeds at 4-5 months had a slightly lower length increment from 4-5 to 6-7 months compared with infants predominantly breast-fed at 4-5 months. Finally, the 122 infants first fed complementary foods at 6-7 months had increments from 6-7 to 9-10 months similar to those of the 154 infants who continued to be predominantly breast-fed. Infants complemented early, late, and very late had similar length-for-age and weight-for-length at 2-3 months, indicating that nutritional status prior to food introduction was not a determinant of age at introduction of complementary food. The growth data collected in this study confirm the importance of waiting until 6 months of age to introduce complementary foods.

Effect of early, short-term supplementation on weight and linear growth of 4-7-mo-old infants in developing countries: a four-country randomized trial.

The effect of supplementation on growth was tested by means of four similar controlled randomized trials in the Congo (n = 120), Senegal (n = 110), Bolivia (n = 127), and New Caledonia (n = 90). Four-month-old infants were randomly allocated to supplement or control groups. A cereal-based precooked porridge was offered twice daily for 3 mo and consumption was monitored. Both groups were free to eat local food. At 7 mo of age, all infants were still breast-fed in the Congo, Senegal, and Bolivia compared with 47% in New Caledonia. Mean daily consumption of the supplement varied among countries (558-790 kJ/d). Mean length at 4 mo was lowest in Bolivia, higher in Senegal and the Congo, and near the National Center for Health Statistics reference in New Caledonia. The mean 4-7 mo length increment was 0.48 cm higher for supplemented than for control infants in Senegal (P < 0.05), whereas weight increments did not differ. No significant effect was found in the other countries.

PIP: Findings from this study of the link between nutritional supplementation during breast feeding and infant growth disagree with earlier studies. The effect of nutritional supplementation on growth in length was only modest, but significant only in Senegal and not significant in the Congo, Bolivia, and New Caledonia. It is hypothesized that food supplementation during the 4-7 month period would have a positive effect on linear growth. This study included four controlled randomized trials among 120 infants in the Congo, 110 infants in Senegal, 127 infants in Bolivia, and 90 infants in New Caledonia. The infants were 4 months old when placed in the supplement or control groups. Supplementation included the addition of a cereal-based precooked porridge twice daily for 3 months. Both groups continued to eat local foods. Breast feeding patterns were different in New Caledonia, where only 47% of infants were still breast fed at 7 months of age. Mean daily supplementation varied among countries, from 558 to 790 kJ/day. Mean length was lowest in Bolivia, higher in Senegal and the Congo, and close to the US National Center for Health Statistics reference measures in New Caledonia. The study was conducted in rural parts of Senegal and New Caledonia and periurban parts of Bolivia and the Congo. Supplementation was supervised by field workers. The samples included infants with a length-for-age score of -2.5 or higher and a weight-for-length Z score of -2 or higher at 4 months. Anthropometric measurements were taken at 4 months and 4, 8, and 13 weeks later (at 4.9, 5.8, and 7.0 months of age). 24-hour food recalls were collected monthly for consumption of breast milk, special local infant food, commercial "western" baby food, milk substitutes, family food, water, and other than milk liquids.

Infant feeding and nutritional status: the dilemma of mothers in rural Senegal.

OBJECTIVE: To describe infant feeding practices in rural Senegal in relation to age and nutritional status. The main hypothesis to be tested was whether mothers modulate feeding in response to growth and nutritional status of their infants. DESIGN: A cross-sectional survey using qualitative 24-h recalls and lifetime recalls to assess feeding practices, and using weight and recumbent length measurements to assess nutritional status. SETTING: Three health clinics in the Fatick region, a rural area of Senegal, West Africa, covering a population of 26,600. SUBJECTS: All 2-10-month-old infants attending four immunization sessions in 1991 (n = 1174; 80% of convoked infants). MAIN OUTCOME MEASURES: Prevalence of feeding with additional food (gruel, family diet and food of animal origin), weight-for-length and length-for-age. RESULTS: All infants were breastfed. A supplement had been given the day before the survey to 10% of infants aged 2-3.9 months, 30% of infants aged 4-5.9 months and 45% of those aged 6-6.9 months. The main food items were watery millet gruel and family diet (millet or rice). Gruel was given in response to perceived breast-milk insufficiency. Animal products were seldom eaten at any age. Length-for-age and weight-for-length were significantly lower among infants supplemented with millet gruel, when adjusted for age; while no such relationship was found with family diet. CONCLUSION: Mothers preferentially fed gruel to small, thin infants.

PIP: During immunization sessions in May, July, September, and December 1991 at three health clinics in the Fatick region in rural Senegal, interviews with mothers of 1174 infants 2-10 months old and anthropometric measurements of these infants were conducted to determine food consumption patterns according to age and to compare these patterns with the nutritional status of the infants. All the infants had been breast fed the day before the survey. No infant was exclusively breast fed, however. All infants were given water, most beginning with the first week of life. More than 25% of the infants had already consumed some additional food at least once at 3-3.9 months of age. 10% of infants 3-3.9 months old, 30% of those 4-5.9 months old, and 45% of those 6-6.9 months old had eaten other food the day before the survey. The most common food supplements were watery millet gruel and family diet (millet or rice). Mothers tended to give infants millet gruel because they perceived an insufficiency of breast milk. Their perception may have been correct because infants 2-3.9 months old who received millet gruel, but not the family diet, were both shorter and thinner than their counterparts (p 0.01). The nutritional status of infants 6-10.5 months old was essentially the same as the status of infants receiving additional food. Mothers gave additional food at irregular intervals. These findings suggest that low nutritional status may lead to supplementation with gruel. Future research should focus on weaning foods as well as on improvement in breast milk consumption in small, thin infants less than 6 months old.

The utility of infancy weight curves for the prediction of linear growth retardation in preschool children.

Routine weight measurements, recorded on health cards of 95 Congolese infants, were collected during a cross-sectional survey as the children were aged 1 to 5 years. The subjects were divided into two groups according to height-for-age (more or less than -2 SD of NCHS reference) at the time of the survey. Adjustment of a mathematical function to the infancy weight curves allowed comparison of groups using the means of the function's parameters: The stunted children had been significantly lighter than the healthy group during infancy. Predictive values of estimated weights and quarterly weight gains were assessed by discriminant analysis and cut-off points were computed. The weight gain between 3 and 6 months of age predicted stunting just as well as weight at age 1 year did. Sensitivity and specificity were at 77% and 74%, respectively. These results suggest that good prediction of stunting is possible from first-year weight measurements.