(Arch Dis Child 1999;80:115-120)

I . In a prospective study of Ugandan children during the 2nd and 3rd years of life, energy intakes 30 : / A bclow the rccommendcd level merc frequently found. Despite this the children gained weight at rates similar to those of healthy English children.2. In view of the low-energy intakes, the activity of the children was studied using a modified form of the diary method of recording activitics. European children living under the same climatic conditions were also studied by this method.3. The Ugandan children spent significantly less time than the European children in activities involving a relatively high rate of energy expenditure such as walking and running.4. This disparity could account for a difference in energy expenditure of the order of 20 kcal (84 kJ)/kg bodp-weight per d. Thc implications are discussed.During the course of a prospective study on a group of Ugandan children living in an environment where kwashiorkor is common, it was observed that in the 2nd and 3rd years of life energy intakes were frequently 700/6 or less of recommended levels (approximately IOO kcal/kg for children aged 1-3 years: Department of Health and Social Security, 1969). In spite of this, many children were able to gain weight and height at rates similar to those of healthy English children (Tanner, Whitehouse & 'l'akaishi, 1966), ~7 h o are known to have much higher energy intakes (Widdowson, 1947). Low energy intakes in children living in areas generally associated with protein malnutrition have also been reported by Gopalan (1968) and Sukhatme (1970).It seemed that either considerably less than the internationally recommended energy intake was required by these children or, alternatively, that they were being forced to compensate for the low-energy intake in some way other than by reducing their rate of growth. I t is a common impression that Ugandan children living in a traditional rural environment are less active than European children of the same age and living under the same climatic conditions (Wclbourn, 195 j). An objective assessment of their activity has, however, not previously been made. It was decided therefore to investigate the possibility that these children were able to maintain a virtually normal rate of growth because of a reduction in activity, thus lowering their energy requirements . E X P E R I M E N T A L ChildrenThe African children studied, aged between 18 months and 3 years, were living in a rural environment in the vicinity of a small trading centre about zg km from Kampala. All had been seen regularly since the age of 6 months as part of a comprehensive https://www.cambridge.org/core/terms. https://doi

Skinfold standards provide a useful indication of subcutaneous fat. To evaluate skinfold thickness of 252 Cambridge infants over the first 2 years of age, SD scores relative to the Tanner standards were calculated, taking account of skewness in the standards. Cambridge SD scores were low, varying according to age from −1.2 to −1.8 for triceps and −0.6 to −1.2 for subscapular skinfolds. The Tanner skinfold standards were last revised 30 years ago, at a time of high prevalence of infantile obesity, and the present and other studies indicate that infants are now thinner. There is a need for new skinfold standards to reflect this change. Since the Cambridge infants contributed to the recent British height and weight references, it is suggested that their skinfold measurements could also serve as reference points. (Arch Dis Child 1998;78:354-358)

We have performed, by open-circuit indirect calorimetry, a total of 1546 measurements of energy expenditure on 142 nonpregnant, pregnant, or lactating Gambian village women. Of the 47 common daily activities measured, only 7 would be classified as moderate according to internationally accepted standards, the remainder being light (ie requiring less than 3.5 kcal/min). This was unexpected since many of the tasks, judged subjectively, appeared quite demanding. Furthermore there was no increase towards the end of pregnancy in the energy cost of a range of activities requiring 1-5 kcal/min and involving a variety of body movements, despite the substantial weight gains observed. Only for walking was there the expected increase in energy expenditure. Although in the past it has been assumed that the heavier pregnant women would require additional energy for activity, no special allowance for this is included in current dietary recommendations. The present results indicate that, for women from the developing world, no allowance is necessary. The finding that most activities were light is also of relevance to total energy requirements in this community.

Aim: To produce a modification of the British 1990 weight reference reflecting the growth of long‐term breastfed infants. Methods: 120 infants from the Cambridge Infant Growth Study fed breast milk (with no formula) for at least 24 wk, with solids introduced at a mean age of 15 wk, were weighed every 4 wk from birth to 52 wk. Weights were converted to standard deviation scores (SDS) for gender and age post‐term based on the revised British 1990 reference, averaged and smoothed across age, and then converted back to weights to provide modified median weight curves by gender. Other centile curves were constructed assuming the same variability and skewness by age as for the British reference. Results: Long‐term breastfed infants were slightly heavier than the reference at birth and crossed centiles upwards to reach +0.3 SDS at 2 mo, but subsequently crossed centiles downwards to −0.2 SDS by 12 mo. Conclusion: The British 1990 reference, although better than previous growth standards, reflects the growth of long‐term breastfed infants only imperfectly, with mean weight falling by 0.5 SDS from 2 to 12 mo. The provision of breastfeeding‐specific centiles, either as a transparent overlay or as an alternative chart, should be useful for professionals and parents to monitor the weight of long‐term breastfed infants.