|Causes and Mechanisms of Linear Growth Retardation (International Dietary Energy Consultative Group - IDECG, 1993, 216 pages)|
|Effects of macrobiotic diets on linear growth in infants and children until 10 years of age|
The workshop of the International Dietary Energy Consultancy Group in Guatemala (1987) on chronic energy deficiency came to the conclusion that more studies are needed on the relationship between the intakes of energy and nutrients and the pattern of growth: "Such studies are particularly illuminating if they compare groups with different dietary patterns and are particularly important for children below three years" (Schürch & Scrimshaw, 1987). From 1985 onwards we have studied growth patterns of children on macrobiotic diets in the Netherlands, because these children appeared to be significantly lighter and shorter than a control group fed an omnivorous diet (Van Staveren et al., 1985). The macrobiotic diet has characteristics similar to the diet of many children in developing countries, in that it is also mainly composed of foods high in starch and fibre but low in protein. In developing countries, however, such a type of diet often coincides with other unfavorable circumstances which may influence linear growth. In contrast, in our studies we did not find any evidence for the existence of adverse social circumstances, infectious diseases or other confounding factors. Thus, this group of macrobiotic children enables us to study the effects of diet alone.
Macrobiotic children have a very restricted, almost vegan type of diet consisting of grain cereals (mainly rice), vegetables, pulses and sea vegetables, with only small amounts of cooked fruits and occasionally some fish. Meat, dairy products and vitamin D supplements are not being used and fish is rarely given to young children. Intakes of calcium, riboflavin and vitamin D recorded for the macrobiotically fed children were substantially below the Dutch RDAs (Netherlands Nutrition Council, 1981). Our aim was to answer the following questions:
1. At what age does growth faltering in height occur in children fed macrobiotic diets?
2. Which nutritional factors are associated with linear growth retardation'?
3. What is the effect of modification of the diet on linear growth?
In this report, we will speak of growth retardation when a significant difference (P < 0.01) from the median of the Dutch cross-sectional growth reference or from the growth curve of a matched omnivorous control group is observed. Catch-up growth is defined as a positive shift towards the median of the Dutch reference curve or towards the median of the curve of the omnivorous control group.