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OnderzoekUrban and Regional Studies InstitutePopulation Research Centre

Normative indicators of child growth and nutrition – one-size-fits-all?

Principal researcher

Hinke Haisma

Type of research

Rosalind Franklin Fellow


Professor Inge Hutter

Professor Claartje Mulder


  • Department Behavioural Biology, University of Groningen, the Netherlands
  • MRC-Human Nutrition Research, Cambridge, United Kingdom
  • Institute of Child Health, UniversityCollege London, United Kingdom
  • Universidade Federal de Pelotas, Brazil

Summary of the project

Indicators of child growth are used across the globe (a) for monitoring the nutritional status of a population, (b) for making comparisons across countries, and (c) for developing health policy and interventions. Current indicators used by the WHO define general standards to be applied across countries and socio-economic conditions. Such standards have important drawbacks because: 1) they include parameters from medical theories and practices only (e.g. growth, body mass, energy intake): ignoring relevant theories relating to health and nutrition from, for instance, Biology, Sociology and Anthropology; and 2) they are not sensitive to context: are derived from averages in high socio-economic status groups and from industrialised countries, which makes them ill-adjusted to children growing up in other circumstances. The weaknesses observed are similar to those identified by Amartya Sen when he suggests that Growth as a measure for development has to be replaced by a set of Human Development indicators, and that context and agency matter: development has to be measured relative to the desired ‘doings and beings’ which people define in different contexts.

In my research I will use the currently available indicators as a starting point, assess contextual determinants in as far as possible from quantitative objectivist datasets, and will subsequently focus on their socio-cultural and biological context from a broader perspective, to ultimately contribute towards a more interdisciplinary understanding of child growth.

The objectives of this research are fourfold and relate to four projects:

1. To provide an assessment and comparison of contextual determinants of infant and child growth of current WHO indicators of child feeding and growth across (sub)populations. The assessment concerns the validity of the indicators, reviewing them in relation to secondary data from demographic and health surveys in Tanzania, Brazil, India, and the Netherlands;

2. To provide insight into the socio-cultural and biological dimensions of infant and child feeding practices and nutritional outcomes across (sub) populations in order to explore expansions of the range of relevant indicators for child health;

3. To validate two indicators in child nutrition: exclusive breastfeeding duration across (sub)populations, and body mass index (BMI) as an indicator of overweight;

4. To contribute towards an interdisciplinary approach of child growth monitoring.

Methodology for each of the projects will include:

1. Multivariate statistical analysis of secondary data from demographic and health surveys;

2. Ethnography of child feeding practices, anthropometry of child and household members;

3. Isotope techniques for assessing fat mass and fat mass index, and anthropometry for calculating BMI;

4. Expert meetings with scientists and policy makers.

Oral presentations

  • Haisma H, Coward WA, GH Visser, JCK Wells, A Wright, CG Victora. Tracking of early life body composition and effect of energy utilisation on body composition at age 4.5 years. Proceedings of the 14th International Conference of the International Society for Research in Human Milk and Lactation (ISRHML), “The science of human lactation: foundations of Clinical Practice”. Perth, Western-Australia, 30 January – 5 February, 2008.
  • Haisma H, Wells JCK, Coward WA, Duro Filho D, Victora CG, Vonk RJ, Wright A, Visser H. Effect of complementary feeding with cow’s milk on sleeping metabolic rate in breast-fed infants. ESPGHAN pre-congress “Early nutrition and its late consequences”. Paris, 2-3 July 2004. J Paed Gastroenterol Nutrition.
  • Haisma H, Coward WA, GH Visser, RJ Vonk, JCK Wells, A Wright, CG Victora. Influence of breast-feeding pattern and socio-economic status on energy expenditure of breast-fed infants in southern Brazil. Rank Prize Mini-Symposium, Grasmere, UK, December 2002.
  • Albernaz E, Haisma H, Coward WA, Wright A, Victora CG. The use of deuterium for measurement of breast milk intake and complementary feeding. V Congresso Brasileiro de Epidemiología. Curitiba, Brazil, March 2002.
  • Haisma H, Coward WA, Albernaz E, Wright A, Victora CG. Breast milk intake and complementary feeding measured with deuterium in exclusively, predominantly and partially breast-fed infants. Simpósio de Aleitamento Materno. Universidade de Campinas, Campinas, SP, Brazil, August, 2001.
  • Wright A, Coward WA, Haisma H, Albernaz E, Victora CG. The use of deuterium for the assessment of milk intake and complementary feeding in breast-fed babies. In: Rapid Communications of Mass Spectrometry. Congress of Stable Isotope and Mass Spectrometry User Group, Glasgow, United Kingdom, 2001.
  • Haisma H, Kaptein A, Thio B, Vermeer BJ. Social aspects of psoriasis. In: Proceedings of the 6th International Congress on Dermatology and Psychiatry. Amsterdam, The Netherlands, May 1995.


  • Warmelink JC, Stamrood CAI, Paarlberg KM, Haisma HH, Vingerhoets JJM, Willibrord, Weijmar Schultz CM, Van Pampus MG. Posttraumatic Stress Disorder, Anxiety and Depression Following Pregnancies Conceived Through Fertility Treatments. J Reproductive Medicine (in press).
  • Romulus-Nieuwelink JJC, Doak C, Albernaz E, Victora CG, Haisma H. Breast milk and complementary food intake in Brazilian infants according to socio-economic position. Int J Ped Obesity 2011, Jun 6(2-2), e508-14. Posted online 6 September 2010.
  • Waninge A. Ligthart KAM, Kramer J, Hoeve S, Van der Schans CP, Haisma H. 2010. Measuring waist circumference in disabled adults. Research in Developmental Disabilities 31(3), 839-47.
  • Ipema K, Franssen C, Van der Schans CP, Haisma H. Influence of frequent nocturnal home hemodialysis on food preference. J Renal Nutrition 20 (2), 127-133, 2010.
  • Vogel I, Rossum L van, Drongelen K, Haisma H, Mesters I, Wouwe K van, Raat H. ZonMW research report. Motives for women to stop breastfeeding before 6 months of age (in Dutch). Institute for Community Health, Erasmus MC – University Medical Centre Rotterdam, 2009.
  • Kruk J van der, Haisma H. Overweight and obesity in children: what is important for nurses with respoect to signalling, prevention and treatment (in Dutch). Ned. Tijdschr. EBP 2: 20-23, 2007.
  • Haisma H, Coward WA, Visser GH, Vonk R, Wells JCK, Wright A, Victora CG. Socio-economic and environmental factors influence energy utilization in Brazilian breast-fed infants. J. Nutr. 136: 2945–2951, 2006
  • Haisma H, Wells JCK, Coward WA, Duro Filho D, Victora CG, Vonk RJ, Wright A, Visser H. Complementary feeding with cow’s milk alters sleeping metabolic rate in breast-fed infants. J Nutr, 135(8):1889-95, 2005.
  • Santos IS, Gigante DP, Coitinho DC, Haisma H, Valle NCJ, Valente G. Evaluation of the impact of a nutritional program for undernourished children in Brazil. Cad Saúde Pública 21 (3), 776-85, 2005.
  • Haisma H, Coward WA, Albernaz E, Wright A, Victora CG, Barros A. The deuterium-oxide turnover method as a means to detect bias in estimations of complementary food intake. EJCN 59, 93-100, 2005.
  • Haisma H, Jaarsma R, Tierolf B. Transnational evaluation ECASE (European Cooperation for Asylum Seeker Empowerment). Research report, Center for Social Development (CMO) Groningen, 2005.
  • Haisma H, Jaarsma R. Final evaluation Medina (stimulation programme for migrant women to initiate own company). Research report (in Dutch), Center for Social Development (CMO) Groningen, 2005.
  • Haisma H. Energy utilisation of infants in southern Brazil. The influence of socio-economic status and breast-feeding pattern. PhD Thesis, University of Groningen, the Netherlands, 208 p, 2004.
  • Haisma H, Coward WA, Albernaz E, Wright A, Victora CG. Breast milk and energy intake in exclusively, predominantly and partially breast-fed infants. EJCN 57, 1633-42, 2003.
  • Albernaz E, Victora CG, Haisma H, Wright A, Coward WA. Impact of lactation counselling on breast milk intake measured through isotopic methods: a randomized trial. J Nutr 133, 205-210, 2002.
  • Gigante DP, Santos I, Coitinho D, Valle NCJ, Haisma H, Valente GC. Avaliação do impacto do programa nacional do leite, em Alagoas, através de métodos isotópicos: aspectos metodológicos e resultados preliminares. (Impact evaluation of a national milk programme using isotope methods, in Alagoas, Brazil: methodological aspects and preliminary results). Revista Brasileira de Epidemiología 5 (1), 63-70, 2002.
Last modified:18 December 2013 12.02 p.m.