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suggested that the S.F.D. infant might well escape from thepossibility of a long-lasting brain cell defect, provided birthtruly releases it from the restriction on growth.8 8 Animalstudies have suggested that the more rapid the rate of" catch-up " growth after a comparatively short period ofgrowth restriction, the less is the likelihood of a permanentdistortion in the growth programme.9 S.F.D. infants shouldtherefore be made to achieve the best possible rate of earlygrowth. If this is best effected by breast-feeding, thengreater efforts should be made to encourage these mothersto breast-feed. Expressed breast milk or cow’s-milkformulae would appear less effective substitutes.A note of caution is needed, however. Ounsted and

Sleigh’s hypothesis is based on only a small number (4) ofbreast-fed infants compared with 39 bottle-fed babies.Further studies of a greater number of infants must beundertaken to confirm their findings. Long-term assess-ment of growth and psychological development is alsoneeded to determine whether there are any benefits in

slightly improving postnatal growth. In practice thesituation is further complicated by the heterogeneity of theS.F.D. group of infants, which constitutes a number ofdifferent aetiological populations: thus the growth patterns,nutritional requirements, and long-term outlook of thesepopulations might differ considerably amongst themselves.Optimum growth and nutrition of S.F.D. infants remain

to be defined. It is hoped that the Oxford study willstimulate further research into this important yet poorlyexplored field.

Department of Child Health,Welsh National School of Medicine,

Cardiff CF4 4XW. D. P. DAVIES.

DEFINING MALNUTRITION IN THE YOUNGCHILD

SIR,-Professor McLaren and Mr Read (Aug. 2, p. 219)provide an interesting contribution towards definingmalnutrition in the young child. However, a satisfactoryclassification of nutritional status should distinguish thesmall normal from the malnourished child. Perhaps sucha separation is impossible from single height and weightmeasurements.

Assessment of nutritional status from weight-for-heightratio tends to classify the tall child as overweight and theshort child as malnourished. For instance, a child withheight and weight following the Harvard 10 or Tanner andWhitehouse’s 11 97th percentile falls into the overweight(and at some ages, the obese) group of McLaren and Read.In contrast, a child with both height and weight on the3rd percentile is within, or on the edge of, the malnutritiongroup. A child growing " along " the 3rd percentile willcontinue to be classed as malnourished although his annualincrements for height and weight are approximately the50th percentile on standard velocity curves.12A proposed international classification, such as that of

McLaren and Read, should be able to be used with racialand nutritional groups other than those for which it wasoriginally designed. Their chart includes overweight andobese groups. Thus it would seem not unreasonable totest the values of the chart by its application to a group ofnormal British children whom we are now assessing in afollow-up study. Of 84 children between 4 and 5 yearsold, 23 class as overweight or obese on McLaren and

8. Dobbing, J. Pediatrics, Springfield, 1974, 53, 2.9. Schain, R. J., Watanabe, K., Havel, S. ibid. 1973, 51, 240.

10. Stuart, H. C., in Textbook of Pædiatrics (edited by W. Nelson);p. 42. Philadelphia, 1969.

11. Tanner, J. M., Whitehouse, R. H., Takaishi, M. Archs Dis. Child.1966, 41, 454.

12. Tanner, J. M., Whitehouse, R. H., Takaishi, M. ibid. p. 613.

Read’s chart, 7 as mildly malnourished, and 1 as moderatelymalnourished. Not all the overweight group appear fat.In particular, 6 of them have weights on an equivalent orrelatively lower position than their height on standardcharts 11 and one of these actually falls into the obese

category of McLaren and Read. All 6 inappropriately"

overweight " children have heights above the 90th

percentile, but only one has triceps and subscapular skin-folds above the 75th percentile and in several cases one orboth of the skinfolds are below the 50th percentile.13Those classing as malnourished, using McLaren and

Read’s charts, are considerably shorter than the overweightgroup, but apart from one boy with weight just below the3rd percentile and 2 girls with subscapular skinfolds belowthe 3rd percentile, no child has height, weight or skinfoldthicknesses below the 3rd percentile. The majority ofthese measurements are above the 10th percentile for age.Socioeconomic status, dietary history, and clinical exam-ination do not suggest malnutrition. Since their heightsare adequate, they fall very definitely into Waterlow andRutishauser’s " no action " group.14Whether it is better to overestimate the incidence of

malnutrition using McLaren and Read’s charts or, as

McLaren and Read suggest, to underestimate it withWaterlow and Rutishauser’s system, may depend on

circumstances. Nevertheless, a classification that results inan apparent incidence of 10% malnutrition in a relativelywell off and well-fed group of West Midlands childrenseems to have serious disadvantages. Whilst the state ofthe British pound may give us poor nation status, we feelthe true incidence of protein energy malnutrition in theWest Midlands does not... yet.

Children’s Hospital,Ladywood Middleway,Birmingham B16 8ET. E. M. E. POSKITT.

STANDARDISATION OF NOMENCLATUREFOR PREGNANCY-ASSOCIATED ALPHA-2

GLYCOPROTEIN

SIR,-Human serum contains a protein of K-2 electro-phoretic mobility which rises in pregnancy and in users ofmedications which contain oestrogens, such as oral contra-ceptives.15-26 This protein has been variously designated aspregnancy-zone protein, pregnancy-associated <x-2 glyco-protein, pregnancy-associated globulin, <x-2 pregnoglobulin,oc-2 A.P. glycoprotein, pregnancy-associated ex-macro-

globulin, Schwangerschaftsproteing (S,P’3)’ Xh, and Pa 1.To eliminate this plethora of confusing nomenclature

referring to a single protein, we have participated in a pollof the workers who we know to be currently involved in itsinvestigation. As a result of this balloting, we proposethat " pregnancy-associated K-2 glycoprotein " be adopted

13. Tanner, J. M., Whitehouse, R. H. ibid. 1975, 50, 142.14. Waterlow, J. C., Rutishauser, I. H. E. in Early Malnutrition and

Mental Development (edited by J. Cravioto, L. Hambraeus, andB. Vahlquist); p. 5. Stockholm, 1974.

15. Berne, B. H. I.R.C.S. Med. Sci. 1973 (73-10) 10-26-4.16. Bohn, H. Blut, 1973, 26, 205.17. Bundschuh, G. Acta biol. med. germ. 1966, 17, 349.18. Dunston, G. M., Gershowitz, H. Vox sang. 1973, 24, 243.19. Hofmann, R., Straube, W., Klausch, B., Friemel, H., G&uuml;nther, J.

Arch. Gyn&auml;k. 1972, 212, 246.20. Horne, C. H. W., McLay, A. L. C., Tavadia, H. B., Carmichael, J.,

Mallinson, A. C., Laiwah, A. A. C. Y., Thomas, M. A., McSween,R. N. M. Clin. exp. Immun. 1973, 13, 603.

21. Kasukawa, R., Yoshida, H., Yoshida, T. Int. Archs Allerg. appl.Immun. 1973, 44, 302.

22. Lin, T. M., Halbert, S. P., Kiefer, D., Spellacy, W. N. ibid. 1974,47, 35.

23. Rittner, C. Clin. Genet. 1973, 4, 407.24. Stimson, W. H., Eubank-Scott, L. FEBS Letters, 1972, 23, 298.25. Than, G. N., Csaba, I. F., Szabo, D. G. Lancet, 1974, ii, 1578.26. von Schoultz, B., Stigbrand, T. Acta obstet. gynec. scand. 1973,

52, 51.