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J.C. Waterlow
1. More observational studies on different groups in different parts of the world are not needed, unless there are groups presenting special features which allow us to separate out or eliminate some causal factors. Examples would be children on macrobiotic diets or the children described by Skuse.
2. However, linear growth measurements should be incorporated in other studies, as of vitamin A or iodine deficiency, of iron supplementation, etc.
3. Further longitudinal studies of child growth will also be valuable if they are accompanied by good data on fetal growth and maturity.
4. There was some difference of opinion on whether more different physical measurements are needed, e.g. of arm length or crown-rump length. These would be valuable for showing whether stunting is proportionate or is confined to the legs.
5. Although this meeting has not been primarily concerned with outcomes, there is a need for more research on the implications of stunting, particularly its effect on the timing of puberty and on final height. A literature review would be a useful first step.
6. Priority should be given to feeding trials, although there was no consensus about whether these should be done with whole foods, such as milk, or with single individual nutrients, e.g. sulphur amino acids. A protocol should be worked out by a special group, which would take account of past experience.
7. Further surveys of dietary intakes, without intervention, are not recommended unless new methods are used to validate the intakes.
8. Studies are needed on the presence and impact of low-grade infections on linear growth, using modern methods to determine the presence and degree of infection. New methods may have to be developed.
9. It is important to continue the development and use of biochemical markers by collaboration between different centres. Attention must be given to technical aspects to ensure that results are comparable.
10. Importance is attached to the measurement of growth hormone, particularly between the ages of 6 and 12 months, to determine the onset of the childhood phase of growth. In this context there is need to promote the development of methods for measuring GH in urine, which would give an integrated measure of hormone production.
11. It is still very difficult to interpret measurements of GH or IGF-1 in plasma. It is now possible to measure their binding proteins and their receptor proteins. Consideration should be given to measuring these proteins or their mRNAs in samples of muscle, fat or bone obtained by biopsy.