|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|
Children fed macrobiotic diets: Participants were recruited through macrobiotic teachers and during the study by families already participating in the study. Eighty percent (= 173 families; 307 children) of all families within the Netherlands that were eligible for the study were included. Eligible for the study were children below eight years of age in the Netherlands who were Caucasian, had a birth weight of at least 2500 g, a gestational age of 38 weeks or more, did not suffer from a congenital disease and who had been on a macrobiotic diet as described by Kushi (1987) from birth onwards. The educational level of the parents was high: 64% of the fathers and 45% of the mothers had completed college or university education as compared to 17% for men and 9% for women of the Dutch population aged 20-49 years (Central Bureau of Statistics, 1983). Ninety-four percent of the parents had followed a macrobiotic diet for more than 2 years and 72% for more than 5 years. Participants of different studies (outlined below) were representative subgroups of this macrobiotic population.
Children fed omnivorous diets (mixed-longitudinal study): Infants were recruited through eight child health clinics throughout the Netherlands.
2.2.1. Cross-sectional study In order to identify age groups most at risk for growth faltering, a cross-sectional anthropometric study was carried out in the Dutch macrobiotic child population, aged 0-8 years (Oct-Dec 1985). From 243 children the following anthropometric measurements were taken: weight, recumbent length of children below 2 years of age, standing height of children of 2 years and older, and mid-upper arm circumference. For length and height, two observers performed the measurements. Food habits were checked by means of a structured questionnaire including foods and cooking styles which were either typical or atypical for the macrobiotic diet. For detailed description of the methods see Dagnelie et al. (1988).
2.2.2. Mixed-longitudinal study As a next step a mixed-longitudinal study (Jan-Nov 1986) was carried out in macrobiotic infants 4-18 months old (n = 53, birth cohort 1985) and omnivorous controls (n = 57) matched for month of birth, sex, parity, educational level of the father and the residential area. Three cohorts of infants were monitored from 4 to 10 months, 8 to 14 months, and 12 to 18 months, respectively. Weight and recumbent length were taken at 2-monthly intervals. Two food record periods of three days each (precise weighing method) were included in the study design, just before or after the second and third anthropometric visit. A single blood sample was collected by a paediatrician within three months of completing the six-month longitudinal study. For detailed description of methods see Dagnelie et al. (1989a,b).
2.2.3. Two-year follow-up of initial study Based on the findings of the mixed-longitudinal study, dietary recommendations were given to all macrobiotic families in May-June 1987. Five to six months later (Oct-Dec 1987) the initial cross-sectional anthropometric study (Oct-Dec 1985) was repeated in the same macrobiotic population (children now aged 2-10 years, n = 194, i.e. 80% of those children participating in the initial cross-sectional study). Food habits and anthropometric measurements were obtained as in the initial study.