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In Reply: Dr Roberfroid and colleagues have highlighted that different reference populations were used and that this may affect the internal validity of this study. We note, however, that the NCHS reference was used to determine eligibility for preventive supplementation or treatment in the local nutritional program and not to determine inclusion in the study's surveillance activities. Anthropometric data were collected on and available for all children in the study villages. In the survival analyses, children were only excluded if, according to the WHO growth standards, the outcome was present at baseline. Use of the WHO growth standards in the analysis was chosen to facilitate comparison with future studies in which the WHO standards will be increasingly adopted. As the WHO growth standards have been shown more inclusive in classifying children as malnourished than the NCHS reference,¹ this decision resulted in the exclusion of a greater number of children from . . . [Full Text of this Article]

Sheila Isanaka, BA
sisanaka@hsph.harvard.edu
Department of Epidemiology
Harvard School of Public Health
Boston, Massachusetts

Rebecca F. Grais, PhD
Epicentre
Paris, France

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