Human Growth and Development [1st ed.] 978-0-306-41518-0;978-1-4757-0743-4

Table of contents :
Front Matter ....Pages i-xvi
Biomedical and Endocrinological Aspects of Normal Growth and Development (Andrea Prader)....Pages 1-22
The Endocrinology of Male Puberty (M. A. Preece, N. Cameron, M. C. Donmall, D. B. Dunger, A. T. Holder, Janet-Baines Preece et al.)....Pages 23-37
Growth Hormone Secretion in Children of Short Stature (R. Rappaport)....Pages 39-48
Growth Retardation: A Paediatric Approach (M. Vanderschueren-Lodeweyckx)....Pages 49-58
The Interaction between Prenatal and Socioeconomic Effects on Growth and Development in Childhood (S. M. Garn, Shelly D. Pesick, J. J. Pilkington)....Pages 59-70
Biosocial Factors in Infant Mortality: Multivariate Analysis of Rates of Births, Lethal Congenital Defects, and Infant Mortality (E. J. Bowers, R. J. Hickey, L. L. Junker, B. S. Zemel, I. E. Allen, A. B. Clelland et al.)....Pages 71-76
Growth of School Children in Various Polish Populations (M. Szemik)....Pages 77-82
Blood Pressure, Height, Weight and Social Class in Children from the Shetland Islands (M. C. Donmall)....Pages 83-94
Share of Genetic Factors in Growth and Development of Children Based on Longitudinal Studies (Hanna M. Chrzastek-Spruch)....Pages 95-102
Socioeconomic Differences in Body Composition of Hungarian University Students (G. Gyenis, G. Till, I. Abraham)....Pages 103-108
Growth in the 14-Year-Old Children of Mothers Who Smoked during Pregnancy (Paula Rantakallio)....Pages 109-113
Analysis of Growth in Height and Weight of Belgian Children in Relation to Lead Levels in the Air (M.-C. Lauwers, R. Hauspie, L. Thièssen, G. Verduyn, C. Susanne)....Pages 115-124
The Effects of Chronic Noise Exposure on Human Prenatal Growth (L. M. Schell)....Pages 125-129
Liverpool Growth Study: Neonate Anthropometric Standards (P. H. Dangerfield, C. J. Taylor)....Pages 131-137
A Cross-Sectional Study of Growth of Algerian Children from the Tell and the Ahaggar (Sahara) (M. C. Dop, R. Turc, E. Maiza, M. Keddari, P. Rochiccioli, A. Sevin et al.)....Pages 139-156
Growth Norms for Body Weight by Stature and Chest Girth in 6 to 12 Year-Old Children (M. Hebbelinck, J. Borms)....Pages 157-162
Body Size and Maturation in Mexico (Johanna Faulhaber)....Pages 163-171
Population Studies: The Cuban National Child Growth Study (J. R. Jordan, J. A. Gutiérrez-Muniz)....Pages 173-178
Secular Growth in Finland According to Conscript Data in One Province Between 1768–1778 (S. Dahlström)....Pages 179-183
A Search for Secular Growth Changes in the Netherlands Preceding 1850 (G. J. R. Maat)....Pages 185-191
Target Height and Secular Trend in the Swiss Population (L. Molinari, R. H. Largo, A. Prader)....Pages 193-200
Secular Trend in Growth of Zagreb School Children (Zivka Prebeg)....Pages 201-207
Secular Trend for Recumbent Length and Stature in the Fels Longitudinal Growth Study (P. J. Byard, A. F. Roche)....Pages 209-214
Secular Evolution in Brussels Between 1960 and 1980 (M. Vercauteren, C. Susanne, R. Orban)....Pages 215-223
Current Problems of the Secular Trend in Human Populations (N. Wolanski)....Pages 225-233
Birthweight, Gestational Age and Neonatal Morbidity in Four Italian Centres (A. De Scrilli, A. Bossi, M. L. Caccamo)....Pages 235-241
Critical Periods of Human Adipogenesis: The Buccal Fat Pad Model (C. M. Poissonnet, A. R. Burdi, F. L. Bookstein)....Pages 243-252
Body Measurements and Proportions of Preterm and Full-Term Infants in the First Six Years — Results of a Longitudinal Study (Ingeborg Brandt)....Pages 253-269
Interrelationships Between Various Aspects of the Growth Pattern in Weight, and Adult Sex Dimorphism in Weight of West Bengali (India) Children (R. Hauspie, S. R. Das, M. A. Preece, J. M. Tanner)....Pages 271-276
Sex Dimorphism of Height in Two Venezuelan Populations (M. E. López-Contreras, N. Farid-Coupal, M. Landaeta de Jiménez, G. Laxague)....Pages 277-281
Time-Series Analysis of Stature, Body Weight and Urinary Excreted Substances in Five Siblings (Masami Togo, Tomoko Togo)....Pages 283-285
Sexual Dimorphism in Body Build of 6 to 13 Year-Old Boys and Girls (M. Hebbelinck, J. Borms)....Pages 287-301
Contribution to the Study of Sex Differences during Growth of Portuguese Students (Queluz Town) (A. J. Piedade)....Pages 303-310
Measurement of Growth Velocity and Peak Height Velocity in Teenagers (H. C. G. Kemper, Lucienne Storm-van Essen, M. A. van ‘t Hof)....Pages 311-318
Adolescent Antecedents to Gynecological Health (Jane Gardner, Isabelle Valadian)....Pages 319-325
Teeth and Dentition (A. Demirjian)....Pages 327-334
The Relationship Between Dental and Somatic Development in Puberty (U. Hägg, J. Taranger)....Pages 335-341
Eruption of Permanent Teeth in Jats of Haryana (V. Kaul, S. Prakash)....Pages 343-351
Skeletal Maturation in the Early Human Fetus (J. A. Birkbeck)....Pages 353-363
Bone Age Retardation at the Hand and Wrist in Children with Perthes’ Disease (F. Kristmundsdottir, R. G. Burwell, M. H. M. Harrison, W. A. Marshall)....Pages 365-374
Bone Maturation in Turkish Newborns (O. Neyzi, H. Günöz, T. Uzel, A. Celenk, J. Ozsarfati, R. Sait et al.)....Pages 375-385
Standards of Skeletal Maturity of the Ankle and Foot in the First two Years of Life in Spanish Children (E. Sanchez, B. Sobradillo, M. Hernandez, J. Rincon, J. Narvaiza)....Pages 387-396
Skeletal Maturity in Children Brought-Up under Good Socio-Economic Conditions (J. Kopczyńska-Sikorska, Z. Niedźwiecka)....Pages 397-405
Somatometric Method for Predicting the Onset of Puberty (G. A. Angelov)....Pages 407-413
Reproducibility of the TW2 Technique of Novice Raters (J. Borms, M. Hebbelinck, W. Duquet, P. Degreve, M. Van Serveyt)....Pages 415-421
Comparison of Height Predictions with Final Adult Height in Boys with Constitutional Tall Stature (J. H. Brämswig, W. Hermeling, W. v. Petrykowski, G. Schellong)....Pages 423-429
Age at Menarche in Egyptians (Fawzia H. Hussien, Isis Ghaly, Laila Aly, S. Shoukry)....Pages 431-435
Kinanthropometric Research in Human Auxology (R. M. Malina)....Pages 437-451
Factors Affecting Physical Performance with Reference to Heredity (V. Klissouras)....Pages 453-469
Changes in Body Composition and Physical Fitness in Obese Children with Different Treatments (Manuel Pena, Jorge Bacallao)....Pages 471-484
Kinanthropometric Aspects of Development of Maturity in Women Athletes (K. Märker)....Pages 485-495
Human Biological Observations on West-African Schoolchildren (J. Huizinga)....Pages 497-502
Anthropometric Correlates of Strength and Motor Performance in Belgian Boys 12 Through 18 Years of Age (G. Beunen, M. Ostyn, R. Renson, J. Simons, D. Van Gerven)....Pages 503-509
Body Size, Shape and Composition Analysis of Weightlifters and Variables Discriminating Them According to Performance and Age (E. Orvanova, L. Uher, M. Slamka, L. Pataki, L. Ramacsay)....Pages 511-524
The Evolution of Some Crawl Performance Determinant Factors in Women Competitive Swimmers (L. Van Tilborgh, D. Daly, H. Vervaecke, U. Persyn)....Pages 525-534
Nutrition, Physical Work Capacity and Work Output (K. Satyanarayana, A. Nadamuni Naidu, B. S. Narasinga Rau)....Pages 535-540
Development of Maximal Cardio-Respiratory Oxygen Transport Capacity under the Influence of Intensive Physical Training in Boys During the Age Period 12 to 17 Years (Günter Koch)....Pages 541-559
Longitudinal Comparison of Aerobic Power and Heart Rate Responses at Submaximal and Maximal Workloads in Active and Inactive Boys Aged 8 to 16 Years (R. L. Mirwald, D. A. Bailey)....Pages 561-569
Ventilatory Thresholds during Treadmill Exercise in Kindergarten Children (M. Weymans, T. Reybrouck, J. Ghesquiere, D. Van Gerven, H. Stijns)....Pages 571-577
Ventilatory Thresholds as an Estimate of Cardiorespiratory Performance Capacity in Children with Congenital Heart Disease (T. Reybrouck, M. Weymans, H. Stijns, A. De Belva, M. Allegaert, L. Van der Hauwaert)....Pages 579-584
Growth and Skeletal Maturation of Mexican Children 4 to 7 Years, with and Without Diagnoses of Chronic Protein-Energy Malnutrition (Francis E. Johnston, Janet Sharko, Joaquin Cravioto, Elsa De Licardie)....Pages 585-595
Serial Analyses of Fat-Related Variables (A. F. Roche, E. Rogers, Christine E. Cronk)....Pages 597-601
Influence of Feeding Pattern in Early Infancy on Ponderal Index and Relative Weight (O. Neyzi, P. Binyildiz, H. Günöz)....Pages 603-611
Growth in Children with Diabetes (T. J. Lee, S. Stewart-Brown, J. Wadsworth, D. C. L. Savage)....Pages 613-618
Changes in Growth and Body Composition Related to Control in Children with Diabetes (Leslie Sue Lieberman, Arlan L. Rosenbloom)....Pages 619-625
Growth and Development in 5 Patients with Pseudohypoparathyroidism: A Longitudinal Study (E. M. de Wijn, R. Steendijk)....Pages 627-630
Growth and Proportionality in Patients with Down Syndrome (J. Buday)....Pages 631-635
The Effect of Chromium on Glucose Tolerance in Turner’s Syndrome (G. Saner, O. Neyzi, H. Gunoz, N. Saka, V. Yuzbasiyan, S. Cigdem)....Pages 637-641
Back Contour Asymmetry in Schoolchildren: Its Significance for the Early Detection of Idiopathic Scoliosis (R. G. Burwell, N. J. James, F. Johnson, J. K. Webb, Y. G. Wilson)....Pages 643-655
Psychosocial Aspects of Growth (Birgitte R. Mednick, Karen M. Finello, R. L. Baker, S. A. Mednick)....Pages 657-674
The Nature of Development: Implications for the Study of Individual Differences in the Development of Personality and Intelligence (C. B. Hindley)....Pages 675-684
Society, Family and Child Development (E. A. Sand)....Pages 685-697
Associations Between Growth Patterns, Social Factors, Morbidity and Developmental Delay in a Longitudinal Survey of Pre-School Children (A. Chinnock, T. Keegan, P. T. Fox, M. D. Elston)....Pages 699-703
Physical and Mental Growth Controlling for Social Background (Gunilla Westin-Lindgren)....Pages 705-717
The Influence of Various Environments on Psychosomatic Development of Small Children (Maria Zdanska-Brincken, Romana Kurniewicz-Witczakowa, Jadwiga Kopczynska-Sikorska)....Pages 719-731
Current Developments in the Design and Analysis of Growth Studies (H. Goldstein)....Pages 733-752
Review of Models Suitable for the Analysis of Longitudinal Data (E. Marubini)....Pages 753-765
Up-to-Date Cross-Sectional Information in Longitudinal Designs (M. A. Van ‘t Hof)....Pages 767-773
The Use of Multivariate Biometric Methods for the Analysis of Human Growth Data (W. H. Mueller)....Pages 775-787
Some Methodological Problems of a Nation-Wide Cross-Sectional Growth Study in Hungary (Esther Pantó, O. G. Eiben)....Pages 789-795
Mathematical Differentiation of Three Separate Components of the Growth Curve (J. Karlberg)....Pages 797-802
Fitting Growth Curves Using Constrained Splines (J. Oosting, N. J. D. Negelkerke)....Pages 803-806
Fitting Growth Curve Allowing for Periodicities (Thu Hoang, Van Parsons)....Pages 807-813
Back Matter ....Pages 815-836

Citation preview

J. Borms · R. Hauspie · A. Sand C. Susanne · M. Hebbelinck Editors

Human Growth and Development

Human Growth and Development

Human Growth and Development Edited by

J.Borms

R.Hauspie A.Sand C.Susanne M. Hebbelinck Free University of Brussels Brussels. Belgium

Springer Science+Business Media, LLC

library of Congress Cataloging in Publication Data International Congress of Auxology (3rd: 1982: Free University of Brussels) Human growth and development. Based on selection of papers from the Third International Congress of Auxology, held Aug. 26-30, 1982, at the Free University of Brussels, Belgium. Includes bibliographical references and index. 1. Human growth-Congresses. 2. Child development-Congresses. 3. Developmental biology-Congresses. I. Borms, J. (Jan) II. Title. [DNLM: I. Child development-Congresses. 2. Growth-Congresses. 3. Anthropometry-Congresses. W3 IN336M 3rd 1982h / WS 103161 1982h) QP84.155 1982 612'.6 83-23080

ISBN 978-1-4757-0745-8 ISBN 978-1-4757-0743-4 (eBook) DOI 10.1007/978-1-4757-0743-4

Based on a reviewed selection of papers presented at the Third International Congress of Auxology, held August 26-30, 1982, at Free University of Brussels, Brussels, Belgium © 1984 Springer Science+ Business Media New York Originally published by Plenum Press New York in 1984

All rights reserved No parr of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher

PREFACE

Research into human growth and development has now attained a considerable age. However, more than 200 years after publication of the first longitudinal study, we are still acquiring fresh insight into the mechanisms and processes of growth in man. Research into human growth advances on a broad front. The complexity of human development and the necessity to examine, for instance, growth phenomena in children over extended periods of time presuppose great diligence and dedicated effort on the part of the investigators. Not least among the many motives that prompt researchers to investigate growth in children is, quite simply, a feeling of responsability for the children's welfare. If one believes that every child has an inalienable right to grow fully towards his O\Jn natural and genetic limits, it follows that every opportunity should be provided for each child. It was with this basic concept in mind that the idea was born to organize a 'Third International Congress of Auxology' at the Vrije Universiteit Brussel in Belgium (1982). In the course of the Second International Congress of Auxology held in 1979 in Havana, Cuba, the International Association of Human Auxology consented to act as patron to the Brussels' organization. The campus of the Vrije Universiteit Brussel thus became the third venue for 'human auxologists', after Rome, 1976 and Havana, 1979. Although the interdisciplinary nature of the subject \vas immediately apparent, the complex multidisciplinary nature of the phenomenon of growth and development necessitated the congress be subdivided into several principal themes. It was decided to focus on biometric, biomedical-endocrinological. psychosocial and kinanthropometric aspects of growth. Although the intrinsic importance of scientific congresses is beyond doubt, it \vas felt that the overall impact \vould be optimal if a written record was kept of the individual papers and discussions at the Congress. Moreover, the multi-disciplinary nature of the subject results - to a certain degree - in research findings on human growth and development be scattered throughout, at times in v

vi

PREFACE

widely divergent publications. A publication which formally assembles original sources and most relevant findings, can only prove helpful to all those involved in the exciting field of human growth and development, by providing immediate access to a wealth of information under one simple cover. The main purpose behind this volume was thus to provide a single written record of current knowledge in the area of human growth and development as culled from different scientific viewpoints. In order to accommodate readers who may be interested primarily in certain aspects and only marginally in others, the chapters of the book were assembled in a slightly different form than the program order adopted for the Congress proper. Four 'keynote' papers, presented by leading specialists, summarize current knowledge in their field. The other papers - 77 in all were selected from a total number of 280. Chapter I on Endocrinology opens with Prof. Prader's paper 'Biomedical and Endocrinologi~al Aspects of Normal Growth and Development.' The other contributions to this chapter come from Drs. Preece, Rappaport and Vanderschueren-Lodeweyckx and deal with growth retardation, growth failure and growth hormone secretion. Nine papers deal in the following chapter with Genetic and Environmental Factors. A third cluster of papers, beginning with Dangerfield's study of growth of Liverpool children, deals with Population Standards and Secular Trend, while chapter 4 assembles ten papers under the heading 'Age Periods.' The next twelve studies have been brought together in a separate chapter 'Maturation.' In the absence of certain data on human growth patterns, much that is said about children and physical exercise is illusory. Chapter 6, Kinanthropometry, should be of interest to all who are concerned with the study of human growth, development, structure and exercise. Chapter 7 contains studies on Nutritional Aspects. All three studies (Johnston, Roche and Neyzi) were longitudinal. The auxological view of medical aspects of development also takes into consideration physio-pathological studies. Chapter 8, Pathology, groups the studies of Drs. Lee, Lieberman, de Wijn, Buday, Saner and Burwell. The topics range from Pseudohypoparathyroidism to Down Syndrome. A comprehensive approach to growth and development of the child, must also include a careful analysis of the social and psychological background. The six papers in Chapter 9 devote special attention to these 'Psychosocial Aspects.' The paper by Dr. Mednick et al. reviews the literature of psychosocial influences on grmvth in the light of the results of a 19-year longitudinal study. The other studies are by Hindley, Sand, Chinnock, Westin-Lindgren and ZdanskaBrincken. The concluding Chapter 10 deals with Methodology. The papers discuss advanced and appropriate methodologies and strategies in the analysis of growth studies. Prof. Goldstein opens this chap-

vii

PREFACE

ter with 'Current Developments in the Design and Analysis.' The other studies present recently acquired knowledge and discuss future developments in the study of human growth. Organization of an international congress is a complex task which demands considerable effort on the part of a great many people. Therefore, we wish to express our sincere thanks to the following persons: Danny De Cock, Johanna Demol, Annemie Fredericq, Katrien Hamelrijck, Gina Plas, Freddy Raeymaekers, Marguerite Van Mechelen, Linda Vermeersch and Dr. Alex Wachholder. Our appreciation also goes to the following institutions for their sponsorship: International Union of Biological Sciences, Ministere de l'Education Nationale et de la Culture Fran~aise, Ministerie van Nationale Opvoeding en Nederlandse Cultuur, }linisterie van Vlaamse Gemeenschap (Ministerie van Vlaamse Cultuur), National Fund for Scientific Research (Belgium), Universite Libre de Bruxelles, Vrije Universiteit Brussel, and the World Health Organization. Publishing a book such as the present one is also a major undertaking, not unlike running a full marathon. Clearly, the editors are most grateful to the authors for their scholarly contributions. They are also appreciative of the genuine spirit of international scientific cooperation shown by the reviewers - listed on the next page of this book - whose expertise and professional and scientific dedication helped significantly in the accomplishment of this delicate task. Moreover, we believe that this review procedure - in spite of the fact that it delayed publication by several months - very significantly enhanced the quality and scientific rigour of the book. The special arrangements concluded with the publishers meant that the entire preparatory work - both scientific and administrative - had to be carried out at the Vrije Universiteit Brussel. In this respect, a word of thank goes to Gilberte Lievens, Chris Lebon and Julien Dewandel for typing the manuscripts and for solving technical problems. We are also most grateful to Edward Crockett who ably assisted the editors during the final stages of manuscript preparation. A very special word of appreciation must also go to Angeline De Troyer who 'orchestrated' the entire logistical aspects of the book from the very beginning until the last manuscript \.;as typed, checked, corrected and safely sent to the publishers.

Brussels 1983

J. BOR.'1S

REVIEWERS

Bailey, D. Beunen, G. Bielicki, T. Borms, J. Brandt, I. Clara, R. Dab, I. Demirjian, A. Duquet, W. Eiben, O.G. Ferro-Luzzi, A. Gam, M. S.

Goldstein, H. Hauspie, R. Hebbelinck, M. Hindley, C.B. Huizinga, J. Johnston, F.E. Jordan, J.R. Karlberg, P. Kemper, H.C.G. Klissouras, V.

Koch, G. Kopczynska-Sikorska, J. Loeb, H. Malina, R.M. Marubini, E. Mednick, S.A. Mueller, W.H. Prader, A. Preece, M.A. Rappaport, R. Roche, A.F. Ross, W.D. Sand, A.E. Susanne, C. Tanner, J.M. Vanderschueren-Lodewijckx, M. Van 't HoE, M.A. Van Wieringen, J.C. Wako, H. Westin-Lindgren, G. Wolanski, N.

VIIi

CONTENTS

ENDOCRINOLOGY Biomedical and Endocrinological Aspects of Normal Growth and Deve lopment . . • . . . . . • . . . . . . . . . A. Prader

1

The Endocrinology of Male Puberty . . . . . . . . . • . M.A. Preece, N. Cameron, M.C. Donmall, D.B. Dunger, A.T. Holder, J. Baines-Preece, J. Seth, G. Sharp, and A.M. Taylor

23

Growth Hormone Secretion in Children of Short Stature . . . . . R. Rappaport

39

Growth Retardation: A Paediatric Approach . . . . . . . . . . . M. Vanderschueren-Lodeweyckx

49

GENETIC AND ENVIRONMENTAL FACTORS The Interaction between Prenatal and Socioeconomic Effects on Growth and Development in Childhood ...... S.M. Garn, S.D. Pesick, and J.J. Pilkington

59

Biosocial Factors in Infant Mortality: Multivariate Analysis of Rates of Births, Lethal Congenital Defects, and Infant Mortality E.J. Bowers, R.J. Hickey, L.L. Junker, B.S. Zemel, I.E. Allen, A.B. Clelland, and R.C. Clelland

71

Growth of School Children in Various Polish Populations M. Szemik

77

ix

CONTENTS

x

Blood Prpssurp, Hpight, Wpight and Social Class in Childrpn from the Shetland Islands . . . . . H.C. Donmall

83

Share of Genetic Factors in Growth and Development of Children Baspd on Longitudinal Studies . . . H.M. Chrzast~k-Spruch

95

Socioeconomic Differences in Body Composition of Hungarian University Students ............... G. Gyenis. G. Till, and I. Abraham

103

Growth in the 14-Year-Old Children of Mothers who Smoked during Pregnancy P. Rantakall i 0

109

Analysis in H.-C. C.

of Growth in Height and Weight of Belgian Children Rplation to Lead Levels in the Air • . . . . Lauwers, R. Hauspie, L. Thipssen, G. Verduyn, and Susanne

The Effects of Chronic Noise Exposure on Human Prenatal Growth . L.M. Schell

115

125

POPULATION STANDARDS AND SECULAR TREND Liverpool Growth Study: Neonate Anthropometric Standards P.H. Dangerfield, and C.J. Taylor A Cross-sectional Study of Growth of Algerian Children from the Tell and the Ahaggar (Sahara) . . . . . " M.C. Dop, R. Turc, E. Haiza, M. Keddari, P. Rochiccioli, A. Sevin, and Ph. Lefevre-Witier

131

139

Growth Norms for Body Weight by Stature and Chest Girth in 6 to 12 Year-Old Children. . . . . . . . . . . M. Hebbelinck, and J. Borms

]57

Body Size and Haturation in Hexico J. Faulhaber

163

Population Studies: The Cuban National Child Growth Study J.R. Jordan, and J.A. Gutierrez-Muniz

173

Secular Growth in Finland According to Conscript Data in One Province between 1768-1778 . . . . . . . . . . S. Dahlstrom

179

CONTENTS

XI

A Search for Secular Growth Changes in the Netherlands Preceding 1850 . . . . . . . . . ..... . G.J.R. Maat

185

Target Height and Secular Trend ln the Swiss Population L. Molinari, R.H. Largo, and A. Prader

193

Secular Trend in Growth of Zagreb School Children Z. Prebeg

201

Secular Trend for Recumbent Length and Stature ln the Fels Longitudinal Growth Study. P.J. Byard, and A.F. Roche

209

Secular Evolution in Brussels between 1960 and 1980 M. Vercauteren, C. Susanne, and R. Orban

215

Current Problems of the Secular Trend in Human Populations . . N. Wolanski

225

AGE PERIODS Birthweight, Gestational Age and Neonatal Morbidity in Four Italian Centres ............... A. De Scrilli, A. Bossi, and M.L. Caccamo

235

Critical Periods of Human Adipogenesis: The Buccal Fat Pad Model . . . . . C.M. Poissonnet, A.R. Burdi, and F.L. Bookstein

243

Body Measurements and Proportions of Preterm and Full-Term Infants in the First Six Years - Results of a Longitudinal Study . . . . . . . . . . . . . . . . . 1. Brandt Interrelationships between Various Aspects of the Growth Pattern in ~veight, and Adult Sex Dimorphism in Weight of West Bengali (India) Children . . . . R. Hauspie, S.R. Das, M.A. Preece, and J.M. Tanner Sex Dimorphism of Height in T\"o Venezuelan Populations M.E. L6pez-Contreras, N. Farid-Coupal, M. Landaeta de Jimenez, and G. Laxague Time-Series Analysis of Stature, Body Weight and Urinary Excreted Substances in Five Siblings. .... M. Togo, and T. Togo

253

271 277

283

XII

COf\JTENTS

Sexual Dimorphism 1n Body Build of 6 to 13 Year-Old Boys and Girls . ............... M. Hebbelinck, and J. Borms

. . . 287

Contribution to the Study of Sex Differences during Growth of PorLuguese Students (Queluz Town) . . . . . . . . . . 303 A.J. Piedade Measurement of Growth Velocity and Peak Height Velocity in Teenagers ........ ...... . . . 311 H.C.G. Kemper, L. Storm-van Essen, and M.A. van 't Hof . . . 319

Adolescent Antecedents to Gynecological Health J. Gardner, and I. Valadian MATURATION Teeth and Dentition A. Demirjian

. . . . . . . . . . . . 327

The Relationship between Dental and Somatic Development in Puberty . . . . . . . . . . . . . . . . . . . 335 U. Hagg, and J. Taranger Eruption of Permanent Teeth in Jats of Haryana V. Kaul, and S. Prakash Skeletal Maturation in the Early Human Fetus J.A. Birkbeck

. . . . . . . . 343 . . . . . . . . . 353

Bone Age Retardation at the Hand and Wrist in Children with Perthes' Disease . . . . . . . . . . . . . . F. Kristmundsdottir, R.G. Burwell, M.H.M. Harrison, and W. A. Marshall

. . 365

Bone !1aturation in Turkish Newborns . . . . . . . . . . . . . . 375 O. Neyzi, H. Gunoz, T. Uzel, A. Celenk, J. Ozsarfati. R. Sait, and N. Yenerer Standards of Skeletal Maturity of the Ankle and Foot in the First Two Years of Life in Spanish Children . . . . . 387 E. Sanchez, B. Sobradillo, M. Hernandez, J. Rincon, and J. Narvaiza Skeletal Maturity in Children Brought-up under Good SocioEconomic Conditions . . ...... . . . . . . 397 J. Kopczynska-Sikorska, and Z. Niedzwiecka Somatometric Method for Predicting the Onset of Puberty . . . . 407 G.A. Angelov

xiii

CONTENTS

415

Reproducibility of the TW2 Technique of Novice Raters . J. Borms, M. Hebbelinck, W. Duquet, P. Degreve, and M. Van Serveyt Comparison of Height Predictions with Final Adult Height in Boys with Constitutional Tall Stature J.H. Bramswig, W. Hermeling, W.v. Petrykowski, and G. Schellong

. . . 423

Age at Menarche in Egyptians . . . . . . . . . . . . . . . . . 431 F.H. Hussien, I. Ghaly, L. Aly, and S. Shoukry KINANTHROPOMETRY Kinanthropometric Research in Human Auxology R.M. Malina

. . . . . . . . . 437

Factors Affecting Physical Performance with Reference to Heredi ty .................. V. Klissouras

. . . 453

Changes in Body Composition and Physical Fitness in Obese Children with Different Treatments . . . . . . . 471 M. Pena, and J. Bacallao Kinanthropometric Aspects of Development of Maturity in Women Athletes . . . . . . . . . . . . . . . . . . . . 485 K. Marker Human Biological Observations on West-African Schoolchildren . . . . . . . . . . . . . . . . . . . . . . . . 497 J. Huizinga Anthropometric Correlates of Strength and Motor Performance in Belgian Boys 12 through 18 Years of Age . . . . . G. Beunen, M. Ostyn, R. Renson, J. Simons, and D. Van Gerven Body Size, Shape and Composition Analysis of Weight lifters and Variables Discriminating them According to Performance and Age . . . . . . . . . . . . . . . . . E. Orvanova, L. Uher, M. Slamka, L. Pataki, and L. Ramacsay The Evolution of Some Crawl Performance Determinant Factors in Women Competitive Swimmers L. Van Tilborgh, D. Daly, H. Vervaecke. and U. Persyn

503

511

525

xiv

CONTENTS

Nutrition, Physical Work Capacity and Work Output . K. Satyanarayana, A.N. Naidu, and B.S. Narasinga Rau

. . . 535

Development of Maximal Cardio-Respiratory Oxygen Transport Capacity under the Influence of Intensive Physical Training in Boys during the Age Period 12 to 17 Years . . 541 G. Koch Longitudinal Comparison of Aerobic Power and Heart Rate Responses at Submaximal and Maximal Workloads in Active and Inactive Boys Aged 8 to 16 Years . . . . . . . 561 R.L. Mirwald, and D.A. Bailey Ventilatory Thresholds during Treadmill Exercise in Kindergarten Children . . . . . . . . . . . . . . . . 571 M. \"eymans, T. Reybrouck, J. Ghesquiere, D. Van Gerven, and H. Stijns Ventilatory Thresholds as an Estimate of Cardiorespiratory Performance Capacity in Children with Congenital Heart Disease . . . . . . . . . . . . . . . . . T. Reybrouck, H. Weymans, H. Stijns, A. De Belva, M. Allegaert, and L. Van der Hauwaert

. . 579

NUTRITIONAL ASPECTS Growth and Skeletal Maturation of Mexican Children 4 to 7 Years, with and without Diagnoses of Chronic ProteinEnergy Malnutrition . . . . . . . . F.E. Johnston, J. Sharko, J. Cravioto, and E. De Licardie Serial Analyses of Fat-related Variables A.F. Roche, E. Rogers, and C.E. Cronk

. 585 . 597

Influence of Feeding Pattern in Early Infancy on Ponderal Index and Relative \.,'eight . . . . 603 O. Neyzi, P. Binyildiz, and H. Gunoz PATHOLOGY Growth in Children with Diabetes . . . . . . . . . . . . 613 T.J. Lee, S. Stewart-Brown, J. Wadsworth, and D.C.L. Savage Changes in Growth and Body Composition Related to Control in Children with Diabetes . . . . . . . . . . . . . . . . 619 L.S. Lieberman, and A.L. Rosenbloom

CONTENTS

xv

Growth and Development in 5 Patients with Pseudohypoparathyroidism: A Longitudinal Study . . . . . . . . . . E.M. de Wijn, and R. Steendijk

627

Growth and Proportionality in Patients with Down Syndrome . . . . .. J. Buday

631

The Effect of Chromium on Glucose Tolerance in Turner's Syndrome . . . • . . . . . . ..... G. Saner, O. Neyzi, H. Gunoz, N. Saka, V. Yuzbasiyan, and S. Cigdem Back Contour Asymmetry in Schoolchildren: Its Significance for the Early Detection of Idiopatic Scoliosis R.G. Burwell, N.J. James, F. Johnson, J.K. Webb, and Y.G. Wilson

637

643

PSYCHOSOCIAL ASPECTS Psychosocial Aspects of Growth . . . . . . ....... B.R. Mednick, K.M. Finello, R.L. Baker, and S.A. Mednick The Nature of Development: Implications for the Study of Individual Differences in the Development of PersQnality and Intelligence . C.B. Hindley Society, Family and Child Development E.A. Sand Associations between Growth Patterns, Social Factors, Morbidity and Developmental Delay in a Longitudinal Survey of Pre-School Children . . . . A. Chinnock, T. Keegan, P.T. Fox, and M.D. Elston Physical and Mental Growth Controlling for Social Background . . . ...•.. .•.. G. Westin-Lindgren The Influence of Various Environments on Psychosomatic Development of Small Children . . . . . . . . . M. Zdanska-Brincken, R. Kurniewicz-Witczakowa, and J. Kopczynska-Sikorska

657

675 685

699

705

719

CONTENTS

METHODOLOGY Current Developments in the Design and Analysis of Growth Studies . . . . . . . . . . . . . . . . . • 733 H. Goldstein Review of Models Suitable for the Analysis of Longitudinal Data . . . . . . . . . . . . . . . . 753 E. Marubini Up-to-date Cross-sectional Information in Longitudinal Designs . . . . . . . . . . . . . • . . . • . . . . . • . 767 M.A. van 't Hof The Use of Multivariate Biometric Methods for the Analysis of Human Growth Data . . . . . . . . . . 775 W.H. Mueller Some Methodological Problems of a Nationwide Cross sectional Growth Study in Hungary . . . . . . . . . . . . 789 E. Panto, and O.G. Eiben Mathematical Differentiation of Three Separate Components of the Growth Curve . • . . . • . . . . . . . . . . 797 J. Karlberg Fitting Growth Curves Using Constrained Splines • . . . . . . . 803 J. Oosting, and N.J.D. Nagelkerke Fitting Growth Curves Allowing for Periodicities T. Hoang, and V. Parsons

. . . . . . . 807

List of Contributors

817

Index .

827

BIOMEDICAL AND ENDOCRINOLOGICAL ASPECTS OF NORMAL GROl-lTH i\i\lD DEVELOPMENT * Andrea Prader Department of Pediatrics, University of Zurich Kinderspital, Zurich, Switzerland

As a pediatrician and clinician, I am preoccupied with abnormal growth and maturation and the study of causes and therapeutic possibilities of such abnormal situations. However, one cannot do this without becoming deeply interested in normal growth and maturation. Without knowledge of normal growth and development a precise and meaningful analysis of abnormal growth and maturation is not possible. Knowledge of the mechanisms regulating normal growth help us to recognise the causes of growth deficiencies. On the other hand, abnormal growth frequently represents - as I will demonstrate an 'experiment' of Nature which permits a better insight into the control mechanisms of normal growth. Thus, there is an interaction and a crossfertilisation between studies of normal and studies of abnormal growth. For me, this crossfertilisation is the most exciting aspect of our work. LONGITUDINAL GROWTH ANALYSIS Let us first look at the general pattern of human growth from birth to adulthood. Fig. 1 shows the median curves of height or growth distance in cm and of growth velocity in cm per year in normal girls and boys. These curves are based on results of the first Zurich longitudinal study of grm-lth and development (1954-1980) which studied 184 children from birth to adul thood and which \.as part of an international longitudinal study coordinated by the International Childrens Center in Paris. Host of the results prespntpd here derive from this study.

*

The original studies reported in this review were supported by the Swiss National Science Foundation and Thp Fritz Hofmann-LaRoche Foundation. The following medical colleagues and mathematicians have greatly contributed: R. Largo and M. Zachmann; Th. Gasser. L. Molinari, W. Stiitzle, G. \vol£.

A. PRADER

2

i

160

1 -i

140 120

14 12 :;;. "-

E 10

~

f

8 6

>

~

'al :I:

Age

4 2

0

2

4

6

8

10

12

14

16

18 Y

Fig. 1. Normal growth: median values from the first Zurich longitudinal growth study.

As the distance curve shows, prepubertal height is nearly identical in both sexes with a minimal difference in favour of boys. This is caused by a slight sex difference in perinatal growth velocity. Prrpubertal growth velocity is identical in girls and boys. It is fastest in early infancy and decreases first quickly and then slowly to a nadir, the minimal prespurt height velocity, which is then followed by the adolescent growth spurt. The declining prepubertal velocity is interrupted by a small growth spurt around the age of 7, ~nown as the mid-growth spurt. The pubertal growth spurt in girls occurs earlier and is smaller than in boys, which largely explains the sex difference in adult height.

BIOMEDICAL ASPECTS OF NORMAL GROWTH

3

The most interesting aspects of growth are the two spurts, the small mid-growth spurt and the massive adolescent growth spurt, and the sex difference in perinatal growth, adolescent growth and adult he igh t. ADULT HEIGHT, HORMONE DEPENDENCY AND SEX DIFFERENCE As everyone knows, there is a sex difference in adult height. In various studies a difference of 10-14 cm has been found. At first sight, one would tend to believe that this difference is due to the different effect of the ovarian and testicular hormones. It is well known that normal adult height cannot be reached if growth hormone, thyroid hormones or insulin are deficient. By contrast, the sex hormones have scarcely any influence on adult height. Untreated XY-individuals with deficient gonadal function as seen in gonotropin deficiency, anorchia or castration, and pure XY-gonadal dysgenesis reach normal adult height, and XX-individuals ~,ithout gonadal function, as seen in gonotropin-deficiency or pure XX-gonadal dysgenesis, also exhibit normal height. Thus, the gonadal steroids do not appear to be important for reaching normal adult height. They do however decrease adult height if present too early and/or in large amounts as seen in precocious puberty and in congenital adrenocortical hyperplasia. In contrast to adult height the adolescent growth spurt clearly depends on gonadal steroids. There is no adolescent growth spurt without gonadal steroids. I will discuss later in some detail the influence of the gonadal steroids on the adolescent growth spuri. Apparently, individuals without gonadal function reach normal height without going through an adolescent growth spurt. We conclude that the gonadal steroids scarcely influence final height but that they are strong modulators of growth velocity. In our longitudinal growth study we found a sex difference in adult height of 12.5 cm. An analysis of its components gave the following results (Largo et al., 1978): (I) + 1.5 is caused by more prepubertal growth in boys, which occurs in the perinatal period; (2) + 6.5 cm is due to the spurt's delay in boys; (3) + 6 cm is caused by the higher peak in boys, and finally (4) - 1.5 cm is explained by more post-spurt growth in girls. Other authors have found similar results, at least for the first three components. As \lill be discussed later, the increased testosterone level in boys probably explains the first and the third components but not the other two. PUBERTAL GROWTH SPURT: TIMING; SKELETAL MATURATION RATION

fu~D

SiXUAL MATU-

It is convenient to use the following parameters to define the timing of the adolescent growth spurt: the starting point is the

A. PRADER

4

age of minimal prepubertal height velocity (A~V); the peak is reached at the age of peak height velocity (APHV); and the spurt ends when adult stature is attained. Since this point cannot be identified with precision we have selected the age when 99 % of adult height (99AH) is completed. This point can readily be determined in longitudinal studies. Table 1 is a timetable of the adolescent growth spurt in relation to age and maturity. It shows the mean values and, in brackets, the SDs. Let us look first at the top three lines. MHV occurs at 9.9 years in girls and at 11.6 years in boys, PHVat 12.1 years in girls and at 14.0 years in boys, and 99AH is reached at 15.2 years in girls and at 16.8 years in boys. The SDs are always about 1 year. The sex difference is 1.6 to 1.9 years. The following three lines represent bone age (TW2-20 bones) at MHV and PHV. The sex difference is 1.8 and 2.0 years. The a~e at the radiological appearance of the sesamoid bone is also given as an additional indicator of skeletal maturation. This is 11.4 years in girls and 13.6 years in boys with a sex difference of 2.2 years. The SDs for bone age are similar to those for chronological age, namely about 1 year.

Table 1: Time Table of the Adolescent Growth Spurt in Relation to Age and Maturity. First Zurich Longitudinal Growth Study. Girls Age (y)

Bone Age (y) TW2-20

Interval (y) longitudinal

Boys

Difference

- MHV

9.9 ( 1 .2)

11.6 ( 1 .0)

1.7

- PHV

12.1 (1.0)

14.0 (0.9)

1.9

- 99AH

15.2 (1.0)

16.8 ( 1. 1)

1.6

- MHV

9.6 ( 1.2)

11.4 ( 1.4)

1.8

- PHV

12.0 (0.7)

14.0 (0.8)

2.0

- Sesamoid

11.4 ( 1 .2)

13.6 ( 1.3)

2.2

- ANHV-APHV

2.3 (0.6)

2.4 (0.6)

0.1

- APHV-A99AH

3.0 (0.7)

2.8 (0.6)

0.2

- Total

5.2 ( 1. I)

5.2 (0.9) )

Percent of Adult - AMHV Height Attained - APHV

)

82.9 (3.3)

82.2 (2.8) ) none

90.5 (2.0)

) 90.0 ( 1.6)

)

5

BIOMEDICAL ASPECTS OF NORMAL GROWTH

The next three lines define the duration of the time intervals between MHV and PHV, between PHV and 99AH and of the total adolescent growth spurt. The duration of the total spurt is 5.2 years in both sexes. The prepeak period seems to be longer in boys and the postpeak period longer in girls. The last two lines specify the percentage of adult height attained at MHV and at PHV. It is highly interesting to note that there is no sex difference in these values. The contents of table I may be summarized as fo11o,.,s. The we11known difference of about two years between the adolescent growth spurt in boys and girls is confirmed. However, despite the sex difference in chronological age and bone age, skeletal development or maturity is identical in both sexes (as indicated by the appearance of the sesamoid bone about half a year before PHV). Maturity - as defined by the relative distance from adult height - is also identical. Thus, the adolescent spurt begins and peaks in both sexes at the same maturity stage, i.e. at the same moment in relation to skeletal maturity and relative distance from adult height. Fig. 2 shows the time relation between adolescent growth and sexual maturation. The vertical bars indicate MHV, PHV and 99AH. The arrow S before PHV indicates the appearance of the sesamoid bone. Chron. Age

10

11

13

12

14

15

16

17

18

99AH Pubic Hair Breasts Ax. Hair Menarche Fertility

cf

MHV 3ml

99AH

, PHV

••e~------"II----...eEnd P5

Testic. Vol.

P2ee------I___e---- -eP6

Pubic Hair

--eG 5

G 3 ______

Penile Growth Ax. Hair

~Ax2

ev

Voice Adult Fertility Chron. Age

10

11

12

13

14

15

16

17

18

Fig. 2. Adolesc~nt growth and sexual development (Zurich longitudinal growth study).

6

A.PRADER

In girls, pubic hair (P2) and breast development (B2) begin between MHV and PHV and reach maturity about 1 year before 99AH. Axillary hair (Ax2) appears around or just after PHV, and menarche (M) occurs always after PHV. In boys, the start of testicular growth is defined by the 3ml stage and the end by the stage when testicular volume remains stable. Based on these definitions testicular growth begins just after MHV and ends late in the descending part of the growth spurt. Pubic hair (P2) and penile growth (G3) begin between MHV and PHV. P5 is reached in the first part of the descending spurt and P6 only after 99AH. Penile growth ends shortly after PHV. The total duration of penile growth is remarkably short, just about 2 years, compared to the much longer period necessary for testicular growth. Penile growth is of course purely androgen dependent whereas testicular growth is a much more complicated process depending on the gonadotropins and on testosterone. Axillary hair (Ax2) appears, as in girls, around or shortly after PHV, followed slightly later by the development of the adult voice (V). In our study this point is always reached after PHV, just as menarche in girls. To complete the picture of sexual maturation I have indicated what we know about the age when fertility (F) is reached. In girls, various studies have shown that ovulatory cycles are rare in the first year after menarche, account for about 50 i. of all cycles two years after menarche and become more or less regular only about 5 years after menarche (Apter, 1980; Lemarchand-Beraud et al., 1982). I have taken the two-year limit, when 50 i. of the cycles are ovulatory, as the mean age of fertility. In boys, mature sperm cells have been found in the urinary sediment soon after the age of 13 (Richardson and Short, 1978). At this age testicular volume is about 8 mI. In our experience men with a testicular volume of only 8 ml may indeed be fertile. I am aware that the criteria presented for fertility are relatively weak. However, there is no doubt that boys reach fertility in an earlier phase of their adolescent development than girls. With the exception of fertility, the timing of sexual maturation in relation to the adolescent growth spurt and the order of the appearance of the pubertal phenomena are very similar in both sexes. And they occur, let it be emphasized, at the same stage of maturity as far as skeletal development and relative distance from adult height are concerned. As shown in table I, the SDs of the parameters MHV, PHV and 99AH in relation to chronological age and bone age are always about one y~ar. The same is true of the SDs of the variables of sexual maturation. One might conclude, with Marshall(1974), that the adolescent growth spurt and sexual maturation are not better related to bone age than the chronological age. This is true in a small normal sample as seen in most longitudinal studies. In clinical experience, however, where many children with accelerated or delayed

BIOMEDICAL ASPECTS OF NORMAL GROWTH

7

adolescence are seen, the situation is quite different. In accelerated adolescence bone age is accelerated and in delayed adolescence it is delayed. In other words, the timing of adolescence, seen in a very large spectrum from extremely early to extremely late adolescence, is better related to bone age than to chronological age. This fact is highly important and helpful for the clinical evaluation of unusual or abnormal patterns of growth and adolescence. The sex difference of about two years in bone age and adolescence emerges very early since the acceleration of skeletal maturation in girls begins already in the perinatal period. Similarly, the bone age acceleration characteristic of very early adolescence and the bone age delay characteristic of delayed adolescence begin long before puberty, generally in the early years of childhood. Thus, the timing of adolescence is programmed many years before it becomes visible. Since bone age and adolescence are both expressions of the general maturation process it is not surprising that they are linked. The interesting questions are as follows: Why is bone maturation faster in girls than in boys ? And why is it faster in some individuals than in others? As will be discussed later, it is difficult to explain these differences by hormonal factors. ADOLESCENT GROWTH SPURT AND THE CONCENTRATION OF PLASMA HORMONES Which are the changes in hormone secretion that could explain the pubertal growth spurt? Let us consider first the adrenal and gonadal sex steroids, then growth hormone (GH) and finally the somatomedins (SMs). The relationship between the adolescent growth spurt and sexual maturation suggests that the sex steroids are the main cause of the spurt. As mentioned, there is no growth spurt without sexual maturation. Fig. 3 shows schematically the increase of the plasma concentration of dehydroepiandrosterone (DHA) representing adrenocortical maturation or the adrenarche, and of estradiol in girls and of testosterone in boys representing gonadal maturation or the gonadarche. It demonstrates that the adrenarche has an earlier onset and is a much slower process than the gonadarche. Since it is the gonadarche which coincides with the growth spurt, it seems likely that the spurt is caused by the gonadarche and not by the adrenarche. As far as GH is concerned, there are several reports showing that the GH response to stimulation and/or the integrated GH plasma values is higher in puberty than in prepuberty (for references, see Prader, 1983). The lower response to stimulation in prepuberty can be increased by a priming dose of sex steroids. Furthermore, it has recently been shown that in puberty GH is less suppressable by glucose than in prepuberty or adulthood (Pieters et al., 1980). On the basis of these findings, it may be concluded that the increasing secretion of sex steroid stimulates the secretion of GH.

A. PRADER

8 c

Q

~

c2 ~g/m3

Adult size (kg)

6.53

147.70

Value at Peak velocity (cm)

Peak velocity (cm/yr)

11.56

164.36

0-2 ~g/m3

Age at Peak velocity (yrs)

Adult size (cm)

Parameter

Table 2: Biological parameters of the fits of the Preece-Baines model I curve to the mixed longitudinal averages of height and weight of the girls living in different zones with a different degree of lead in the air.

N

(J)

r

< m

m

r

» o

m

r

o

-i

Z

o

» -i

r

m

:0

Z

-i

::c

C)

::c o "'T1 ::c m

~

o

:0

G)

122

M.-C. LAUWERS ET AL. 190

HEIGHT (eM)

180

GIRlS

DO

160

ISO WI)

....

130 120

... ...

110 100

90

80

PI:JC

10

II

(years)

10

20

15

VELOCITY (CM/VA)

10 GIRLS 9

8 7 6

5

......................................--..............-.......-......-.- ....-- .... --.- ... -..-.-.... -- .... N::J£ 10

...........__ -..

:":"~

(years)

15

20

Fig. 3: Fitted growth curves and first derivatives (growth velocity curves) to the mixed longitudinal averages of height of the girls from the high concentration area (> 2 ~g PB/m3 ) ( ••• ) and from the low concentration area (0 - 2 ~g Pb/m3 ) (---).

The Student's t-tests on the means in each age class of height and weight of girls and boys were never significant. No significant differences were found in mean birth-weight, distribution of professions of the parents and the scores for hygienic care, between both subsamples. These results suggest that there is no association between the growth patterns for height and weight and the degree of lead pollution in the air at the place of residence of the children.

123

GROWTH OF HEIGHT IN RELATION TO LEAD LEVELS

WEIGHT (KG) 90 GIRLS 10 l'O

10

'"

10 30 20 10

n VELOCrTY

5

10

15

20

15

20

(KGlYR)

10 GIRLS

, • 7

6 5

, 4

2

Ac.E (years) 5

10

Fig. 4: Fitted growth curves and first derivatives (growth velocity curves) to the mixed longitudinal averages of weight of the girls from the high concentration area (> 2 ~g Pb/m 3 ) ( ••• ) and from the low concentration area (0 - 2 )lg Pb/m3 ) (--).

ACKNOWLEDGEMENT We wish to express our gratitute to the Health Control centres: 'Gemeentelijk gezondheidscentrum Hoboken' and 'Gezondheidscentrum Vera Vita' who made it possible to carry out anthropometric measurements. Our thanks also to Hilde Carsau, Hilde Schoeters, Kris Eilers and Greet de Graef.

124

M.-C. LAUWERS ET AL.

REFERENCES Antal, A., Timaru, J., Muncaci. E., Ardevan, E., Ionescu, A., and Sandulache, L., 1968, Les variations de la reactivite de l'organisme et de l'etat de sante des enfants en rapport avec la pollution de l'air communal, Atmospheric Environment, 2: 383. Brown, T., and Townsend, G.C., Adolescent growth in height of Australian Aboriginals analysis by the Preece-Baines function, Annals of Human Biology, (in press). --Darrow, D.K., and Schroeder, H.A., 1974, Childhood exposure to environmental lead, Advances in Experimental Medicine, 48: 425. Dolgner, R., Pelech, L., and Schmidt, P., 1974, Die Reaktion des Schulkindes auf Luftverunreinigungen-Ergebnisse und Erfahrungen aus mehrjihringen Untersuchungen, Zentralblatt fur Bakteriologie, Parasitenkunde, Infektionskrankheiten und Hygiene, I Abt. Orig. A., 227: 101. Habercam, J.W., Keil, J.E., Reigart, J.R., and Croft, H.W., 1974, Lead content of human blood, hair and decidious teeth: correlation with environmental factors and growth, Journal of Dental Research, 53: 1160. Hauspie, R.C., Wachholder, A., Baron, G., Cantraine, F., Susanne, C., and Graffar, M., 1980, A comparative study of the fit of four different functions to longitudinal data of growth in height of Belgian girls, Annals of Human Biology, 7: 347. Krichagin, V.J., 1978, Health effects of noise exposure, Journal of Sound Vibration, 59: 65. Martin, R., and Saller, K., 1957, Lehrbuch der Anthropologie in systematischer Darstellung, B und I, Gustav Fischer, Stuttgart. Nordstrom, S., Beckman, L., and Nordenson, I., 1978, Occupational and environmental risks in and around a smelter in northern Sweden, Hereditas, 88: 43. Patterson, M.D., 1950, Sampling on successive occasions with partial replacement of units, Journal of the Royal Society Bulletin, 12: 241. Preece, M.A., and Baines, M.J., 1978, A new family of mathematical models to describe the human growth curve, Annals of Human Biology, 5: 1. Siege~., 1956, Nonparamatric statistics for the behavioral sciences, Me. Graw. Hill Book Company, Kogakusha, Ltd., Tokyo, 312 p. Tanner, J.M., 1951, Some notes on the reporting of growth data, Hu--. man Biology, 23: 93. Thielebeule Von, U., Pelech, L., Grosser, P.J., and Horn, K., 1980, Korperhohe und Knochenalter bei Schulkindern in lufthygienisch unterschiedlich belasteten Gebieten, Z. Ges. Hyg., 26: 771. Twiesselmann, F., 1969, Development Biometrique de l'enfant a l'adulte, Presses Universitaire de Bruxelles, Brussel, 147 p. Vercauteren, M., 1981, l'Evolution seculaire de la population Bruxelloise entre 1960 et 1980, dissertation, Universite Libre de Bruxelles, 98 p.

THE EFFECTS OF CHRONIC NOISE EXPOSURE ON HUMAN PRENATAL GROWTH

L.M. Schell Department of Anthropology, State University of New York-Albany, Albany, U.S.A.

Acute intense noise is a physiological stressor in man and other animals, but the effect of chronic exposure on human health is not clearly understood. To suggest whether chronic exposure to environmental noise produces health effects in humans, an investigation of the physical growth of children from a noise exposed community was conducted. This report describes the investigation into the prenatal growth of children born to mothers exposed to airport noise. Previous research has described an effect of airport noise on birth weight CAndo and Hattori, 1973; Knipschild et al., 1981; and Schell, 1981). The purpose of this investigation is to discover whether there exists a threshold below which there are no observable effects on prenatal growth. The hypothesis to be tested is that gravidae who were chronically exposed to the most noise from jet airplane traffic will give birth to infants who have experienced less prenatal growth, as measured by birth weight and gestation length, than gravidae who have been exposed to far less noise. MATERIALS AND METHODS The sample was drawn from a suburban community called Airport City in this report. Two hundred and twenty-one births born between 1965 and 1978 to families with a child attending the local elementary school were studied. Multiple births and births to mothers whose noise exposure was poorly documented were excluded, leaving 121 births C67 males and 54 females). Airport City is located adjacent to an international airport and plane traffic affects community noise levels. Noise measurements 125

126

L. M. SCHEL1.

made in 1967 (Bragdon, 1971) and in 1975 (Glaser and Kauders, 1975) show that noise levels vary according to the volume of airplane traffic (high, medium or low mobility) and by location in the community. During periods of high mobility, the 1967 'peak' noise levels (a measurement approximately equivalent to the current L01 measurement (Glaser and Kauders, 1975) ) varied between measuring sites in the community from 79 dBA to 91 dBA. However, when jet planes are taking off, noise levels in Airport City are often 10 dBA higher than the 1967 'peak' measurement. Since sudden peaks in noise level may be the most physiologically stressful (Borg, 1979), noise levels during jet plane takeoffs were used to figure the level of noise while subjects lived at different residences (following noise contour maps from Bragdon, 1971, page 148). Each mother's noise exposure was defined as the noise level at her residence during jet plane takeoffs. If mother changed residences, an average was calculated from noise levels at all residences. For residence outside the study area, 54 dBA was used because this figure represents the noise level in Airport City when no planes are taking off or landing (Bragdon, 1971). Interviews with subject families provided information on mother's residence history, and her reproductive history, cigarette smoking during pregnancy, family income and ethnic background, parents' occupations, birthplaces, education and their reported height and weight (reported height and weight bears an extremely close resemblance to measured values (Stewart et al., 1980) ). Information on birth weight was read from hospital documents. Gestation length was estimated by asking the mother if the birth was earlier or later than the due date she and her physican had determined while she was pregnant. Though this is an inaccurate measure of an individual gestation length, it is not likely to be systematically biased. Errors in estimating many gestation lengths should be distributed randomly with regard to noise exposure, thereby increasing the variance in gestation length. This makes differences between means smaller in comparison to a variance inflated by measurement error. Births were classed according to mother's noise exposure into groups of high (more than 99 dBA) , moderate (90 to 99 dBA) and low (below 90 dBA) exposures. These groups were compared to test the hypothesis of any noise effect. A second comparison contrasted high versus low and moderate groups to discover if a threshold exists for any noise effects. Prior to comparing prenatal growth, the distributions in exposure groups of parents' occupations, birthplaces and of family ethnic backgrounds was compared to determine if it was random. If random, the distribution would not affect the comparison of prenatal growth. All statistical tests but the non-parametric ones were computed with BMDP, 1977 version (Dixon and Brown, 1979). Differences between group means were tested with analysis of variance (ANOVA)

THE EFFECTS OF CHRONIC NOISE EXPOSURE

127

techniques. Adjustments were made for significant heteroscedasticity (as determinded by Bartlett's test) in ANOVAs. The ANCOVA was performed in order to compare means after statistically removing the effects of other confounding variables (e.g., mother's smoking or anthropometry). All of the parametric variables previously enumerated in the description of the interview were possible covariates. Using stepwise regression, a group of covariates was chosen with the largest R2 and F ratio, and having similar slopes across exposure groups. Four covariate models were made, one for each sex variable combination. As had been previously reported (Schell, 1981) few variables correlated highly in this sample with birth weight, and fewer with gestation age. Thus, while the covariance models adjust for the extraneous independent variables, the adjustment should be slight. RESULTS The analysis of parents' birthplaces, occupations and ethnic backgrounds revealed no patterns to their distributions in a sample divided into two or three groups. All chi squares were small and not significant (the largest had an associated probability greater than 0.10). Means and variances of the three exposure groups are presented with the results of the ANOVAs in table I. All absolute differences between exposure groups' means agree with the hypothesis that smaller infants are born to the most noise exposed mothers. The greatest contrast appear between means from the least and most exposed groups. Between them there was a 177 gram difference in males' birth weight means and a difference of 327 grams between those of females. Gestation lengths differed by approximately 10 days in males' and in females' exposure groups. Between low and moderate exposure groups birth weights and gestation lengths were very similar. The results of the ANOVAs revealed a statistically significant difference among the three exposure groups' means of females' birth weights. No other contrasts of the three exposure groups' means reached statistical significance, though when sexes were combined, gestation length means nearly did so. In the ANCOVA, the low and moderate exposure groups were combined, and together, contrasted with the high expofure group. ANCOVA adjustments to means were slight, and statistically significant contrasts were observed for females' birth weights and for males' gestation lengths (table I). DISCUSSION The results presented suggest that noise may have an effect on prenatal growth. The strongest evidence for this comes from the overall similarity in the negative direction of the effects observed

128

L. M. SCHELL

Table I: Comparison of means from exposure groups. 3 Group Contrast

High

J

~

3295

3377

3129

270

270

269

565

674

172

23

24

22

n

24

16

8

24

16

8

x

3443

3459

3422

278

277

278

445

513

361

II

II

10

n

66

35

31

67

36

31

x

3506

3554

3458

280

278

281

459

481

448

10

6

13

n

30

15

15

30

15

15

F

1.38

0.40

6.44*

2.83*

1.40*

I .31 *

P

0.25

0.67

0.01

0.07

0.27

0.30

3465

3149

268

271

133

129

4

5

3464

3425

279

279

75

54

2.

2

F

0.001

3.87

5.30

1.93

P

0.99

0.05

0.03

o . 17

s.d.

s.d.

Low

s.d.

AN OVA

Gestation Length

J&~

x

Moderate

Birth Weight

2 Group Contrast High

x

s.e. Moderate & Low: adj. x s.e. ANCOVA

*Due to significant heteroscedasticity, F was adjusted following Welch's or Brown-Forsythe's technique (Dixon and Brown, 1979).

THE EFFECTS OF CHRONIC NOISE EXPOSURE

129

in comparing groups' birth weights and gestation lengths. Though other explanations are possible, the influence of families' social and biological characteristics did not appear to confound the analysis of noise's effects in this sample. Results from the present study agree with previous studies that discovered an effect of airport noise on birth weight and prematurity rates (Ando and Hattori, 1973; Knipschild et al., 1981; Takahashi and Kyo, 1968). The results tentatively suggest that moderate exposure had no effect on prenatal growth, and that noise exposure must be rather severe before any effects are observed. Similarly, Knipschi1d et a1. (1981) observed that the most severely exposed group contributed a large proportion of low birth weight infants to their sample. It is not understood why birth weight means of females differed so much more than males', especially since the growth of males may be more sensitive to environmental stresses. Interestingly, Knipschild et a1. (1981) also observed a greater effect among females. Conclusions from the results of the present investigation must be regarded as tentative since sample sizes are small and the study design did not determine cause and effect. The present study does suggest that noise cannot be ignored as a possible prenatal stressor in humans and further research is needed to define its scope and power. REFERENCES Ando, Y. and Hattori, H., 1973, Statistical studies on the effects of intense noise during human fetal life, J. Sound and Vibr., 27: 101. Borg, E., 1979, Physiological aspects of the effects of sound on man and animals, Acta Otolargy. suppl., 360: 80. Bragdon, C., 1971, Noise Pollution, University of Pennsylvania Press, Philadelphia. Dixon, W. and Brown, M., eds., 1979, 'BMDP-1977', University of California Press, Los Angeles. Glaser, E. and Kauders, R., 1975, A re-survey and a new baseline of community noise in southwest Philadelphia and vicinity. Paper presented at the 1975 National Noise and Virbration Control Conference, Atlanta, Georgia. Knipschild, P., Meijer, H. and Salle, H., 1981, Aircraft noise and birth weight, Int. Arch. Occup. Environ. Health, 48: 131. Schell, L., 1981, Environmental noise and human prenatal growth, Am. J. Phys. Anthrop., 56: 63. Stewart, A., Brook, R. and Kane, R., 1980, Conceptualization and measurement of health habits for adults in the health insurance study: Vol. II, Overweight, Rand, Santa Monica, California. Takahashi, I and Kyo, S., 1968, Studies on the differences in adaptabilities to the noisy environment in sexes and growing processes, J. Anthrop. Soc. Nippon, 76: 34.

LIVERPOOL GROWTH STUDY: NEONATE ANTHROPOMETRIC STANDARDS

P.H. Dangerfield I and C.J. Taylor 2 1University of Liverpool, Liverpool L69 3BX, England 2

Alder Hey Children's Hospital, Eaton Road, Liverpool England

INTRODUCTION The measurement of body dimensions and the placental weight is known to give a guide to later growth patterns (O'Connell, E.J., Feldt, R.H. and Stickler, G.B., 1970; Winick, M. and Rosso, P., 1969; Badson, S.G., 1970; Davis, P.S. and Davis, J.P., 1970; Zamenhof, M. and Holzman, G.B., 1973), but with the exception of weight, leneth and head circumference, the routine measurement of neonates has been neglected. Techniques for accurate measurement were established as early as 1931 but few current anthropometric standards exist (Backwin, H. and Backwin, R.M., 1931; Gairdner, D. and Pearson, J., 1971; Tanner, J.M. and Whitehouse, R.H., 1973). The present paper presents reliable methods of anthropometric measurement of neonates and a series of normal values bases on these techniques. THE SURVEY The survey included 212 caucasian babies. 53 of each sex were randomly selected from uncomplicated term singleton births at 2 central Liverpool maternity hospitals. They were all measured by the same observer. Gestation was based on an accurately known last menstrual period wherever possible. A full gestational assessment (Dubowitz, L.M.S., Dubowitz, V. and Goldberg, C., 1970) was performed on each baby. The maturity assessment was based on this, together with serial ultrasound measurements of the biparietal diameter available in 64% of the cases. The anthropometric and gestational survey was carried out within 48 hours of birth. 131

132

P. H. DANGERFIELD AND C. J. TAYLOR

Using specially modified Holtairi anthropometric equipment (Holtain Limited, Crymch, Dyfed, South Wales) a total of 27 measurements were made on each baby using techniques as established in the IBP handbook N° 9. (Weiner, J.S. and Lourie, J.A., 1969). These were general body measurements comprising birth weight, crown-heel length, crown-rump length, subischial length, head circumference, head length, head breadth, chest circumference, inter nipple distance, lateral and anteroposterior chest diameters, biacromial and bi-iliac diameters, and limb measurements, made on both s.ides of the body, comprising upper arm, forearm, forearm and hand, dorsum of hand, upper leg, tibia and foot length. The modifications to the Holtain Anthropometric Equipment facilitated their use on the neonate. The neonatometer had the foot blocks removed and replaced by black line markers, enabling the instrument to be .used for both supine length and crown-rump length. A specially manufactured Holtain anthropometer, adapted to give a total travel from 22mm. to 250mm., enabled the instrument to fit within incubators. Small arms were fitted instead of the standard arms, permitting measurement of shorter lengths than the standard instruments normally allows. RESULTS 106 neonates of each sex had 28 individual measurements made in each case. Placental weight, which included cord and membranes, but with excess clot removed, was recorded at birth. Subischial length could be calculated by subtraction of crown-rump length from crown-heel length. Reproducibility of measurement was assessed by repetition of the measurements on the same individual after a lapse of time, and calculated using a standard formula (U.S. Dept. of Health Education and Welfare Public Health Service, 1974). A total of 29 neonates of both sexes were remeasured in this way by the same observer. The results obtained confirmed the accuracy of the techniques employed for all the parameters (Table 1). The calculation of skew and kurtosis, and the construction of a histogram for each variable, enabled the measurements to be assessed for normal distribution. No measurment was found to have abnormal distribution. The mean values for each parameter, with their respective standard diviations are given in the Tables 2 and 3. Table 2 gives the values for the general body measurements and Table 3 the values for the limb measurements.

133

LIVERPOOL GROWTH STUDY

Table I: Intraobserver Error. The reliability of skeletal measurements on 20 neonates measured twice by the same observer. Body measurements

Standard deviation of the difference between first and second measurements

of difference squared (d 2 )

Technical error of the measurement oe in nun.

~

Crown-heel length

I. 27

106

I. 62

Crown-rump length

1.30

158

I. 98

Head circumference

1.3 I

173

2.07

Head breadth

0.90

87

1.47

Head length

2.03

264

2.51

Chest circumference

1.40

323

2.80

Inter nipple distancE'

1.39

198

2.22

Chest lateral diam.

1.30

141

1.85

Chest ap. diam.

I. 18

III

1.62

Biacromial diam.

1.29

224

2.31

Bi-iliac diam.

1.65

157

I. 94

Upper arm length L.

0.91

77

1.37

Forearm length L.

1.44

135

1.82

Forearm & hand length L.

1.50

276

2.61

Dorsum hand L.

1.40

15 I

1.94

Upper leg L.

1.20

170

2.01

Tibia L.

I. 16

94

1.59

Foot L.

1.01

79

I. 40

Technical error of measurement

o=. I

V·

e

d n

=

E(d 2 ) 2

where :

n

difference between first and second measurements number of subjects

P. H. DANGERFIELD AND C. J. TAYLOR

134

Table 2: General body measurements.

= 106)

= 106)

Female (N

Mean

Standard Deviation

Mean

Crown-heel length

508.3

20.1

505.5

Crown-rump length

337.0

16.5

335.0

12.6

Subischial length

171 .9

9.2

170.3

9.7

Head circumference

346.9

12. I

340.3

11.9

Head breadth

96.0

3.1

94.9

3.7

Head length

120.7

4.3

118.4

4.6

82.8

6.2

81.7

6.2

Chest circumference

324.8

16.6

324.6

16.7

Chest lateral diameter

103.0

5.7

104.0

5.6

Chest antero-posterior diameter

97. I

5.4

96.3

5.1

113.4

6.7

113.5

6.8

92.1

6.0

92.5

5.8

Male (N Variable

Inter nipple distance

Biacromial diameter Bi-iliac diameter Weight Placental weight

Standard Deviation llIIJl

17.6

p453.4 gm

464.9

3387.7 gm

444.4

658.9 gm

150.1

652.4 gm

118.5

DISCUSSION The high standard of reproducibility of the techniques and their relative ease of use on a neonate proves the value of anthropometry on the newborn. The recording of the parameters within 48 hours of birth should not detract from their value, since Zamenhof and Holzman (1973) reported that head circumference varied little between 24 and 48 hours. Little change could be expected to be measurable in other parameters. Previous studies have produced a number of general body standards and their comparison with the new standards shows good agreement where the techniques employed were similar (Table 4). Few similar standards are available for limb lengths using anthropometric methods on the neonate. Radiological studies produce marked differences in values for long bones (Naeye, R.L. and Dixon, J.B., 1978) since the unossified epiphysis would not be included in

LIVERPOOL GROWTH STUDY

135

Table 3: Limb measurements.

Variable

Male (N

= 106)

Female (N = 106)

Mean

Standard Deviation

Mean

Standard Deviation

Upper arm length left

84.3

4.7

83.7

4.7

Upper arm length right

84.1

4.4

83.3

4.8

Forearm length left

74.5

3.9

72.5

4.6

Forearm length right

75.1

4.7

73.0

4.7

Forearm and hand length left

133.6

5.7

131.8

5.6

Forearm and hand length right

133.5

5.9

131.7

5.6

Dorsum of hand left

62.2

4.2

62. I

4.9

Dorsum of hand right

61.3

4.3

61.4

4.7

Upper leg length left

103.8

4.9

105.1

5.1

Upper leg length right

103.7

5.0

105.2

5.4

Tibia length left

87.7

4.5

87.5

4.6

Tibia length right

88.1

5.0

87.8

5.0

Foot length left

77.7

3.8

77 .3

3.4

Foot length right

77 .5

3.6

77 .3

3.4

the length measurement, suggesting that direct comparison is not possible. The standards quoted form the basis of an ongoing growth study throughout childhood currently being undertaken in Liverpool. The preliminary presentation of the values for the neonate, both for the general body measurements and for the limb measurements, will permit the construction of percentile values for each variable, enabling the clinical assessment of growth in the neonate to be undertaken. The new standards for limb lengths should prove of great value in the identification of growth dysplasias, especially where short limb dwarfism is suspected. The authors intend to create predictive values for easy clinical use in this field, and to investigate their application.

113

Biacromial diameter

** ***

Mean value male & female. 50% male and female. Bi-cristal diameter.

103

Chest lateral diameter

*

97

78

Foot length

Chest A.P. diameter

83

Internipple distance 325

92

Bi-iliac diameter

Chest circumference

121

347

Head circumference

Head length

172

Subischial length 96

337

Crown-rump length

Head breadth

508

3453

Crown-heel length (nun)

Weight (g)

Taylor ( 1983)

&

&

Naeye Kamioka

319

76

505

341

504

3388

79

77

102***

117

97

341

504

3318.

Bakwin* Dixon** (1931 ) (1978) (1979)

&

Dangerfield Bakwin

113

105

323

80

89

94

342

166

338

504

&

79

340

341

511

3402

97

332

81***

353

506

505

348

3400

3270

112

96

87

321

82

343

335

496

3300

James Hami 11 Vickers et al. et al. & McCanunon** Stuart* Dittman* (1962) (1979) (1979) (1943) (1970)

Altman

Table 4: Comparisons with published standards (values for males only given unless indicated).

:::r

::D

0

r-


-I

~

()

0

Z

:t>

0

::!! m r

::D

m

zG')

:t>

0

:u

w O'l

LIVERPOOL GROWTH STUDY

137

REFERENCES Altman, P.L. and Dittman, D.S., 1962, Growth including reproduction and morphological development, Biological Handbook Series. Babson, S.G., 1970, Growth of low birth weight infants, Pediatrics, 77: 11-18. Backwin, H. and Backwin, R.M., 1931, The technique of measuring the external dimensions of, the body 1n infants, Clin. Invest., 10: 369-375. Davis, P.S. and Davis, J.P., 1970, Very low birth weight and subsequent head growth, Lancet, 2: 1216-1219. Dubowitz, L.M.S., Dubowitz, V. and Goldberg, C., 1970, Clinical assessment of gestational age in the newborn infant. J. of Ped., 77: 1-10. Gairdner, D. and Pearson, J., 1971, A growth chart for premature and other infants, Arch. Dis. Child., 46: 783-787. Hamill, P.V.V., Drizd, C.A., Johnson, C.L., Reed, R.D., and Roche, A.S., 1979, Physical growth: National Center for Health Statistics Percentiles, Am. J. Clin. Nutr., 32: 607-629. Holtain Limited, Crymch, Dyfed, South Wales. James, D.K., Dryberg, E.H. and Chiswick, M.L., 1979, Foot length: a new and potentially useful measurement in the neonate, Arch. Dis. Child., 54: 226-230. Kamioka, H., 1979, Anthropometric measurements of Japanese newborn infants. Japanese J. Hygiene, 34: 420-428. McCammon, R.W., 1970, Hwnan growth and development, Charles C Thomas, Springfield, Illinois, U.S.A., 103-154. Naeye, R.L. and Dixon, J.B., 1978, Distortions in fetal growth standards, Ped. Res., 72: 987-991. O'Connell, E.J., Feldt, R.H. and Stickler, G.B., 1965, Head circumference, mental retardation and growth failure, Pediatrics, 36: 62-66. Tanner, J.M. and Whitehouse, R.H., 1973, Height and weight charts from birth to 5 years allowing for length of gestation, Arch. Dis. Child., 48: 786-789. -u.S. Dept. of Health Education and Welfare Public Health Services, 1974, Resources Administration, 124: (11),80. Vickers, V.S. and Stuart, H.C., 1943, Anthropometry in the pediatricians office, J. Ped., 22: 155-170. Winick, M. and Rosso, P., 1969, Head circumference and cellular growth of the brain in normal and marasmic children, J. Ped., 74: 774-778.

Weiner, J.S. and Lourie, J.A., 1969, Human Biology: A guide to field methods, IBP Handbook N° 9, Blackwell Scientific Publications. Zamenhof, M. and Holzman, G.B., 1973, Study of correlations between neonatal head circumferences, placental parameters and neonatal body weights, Obstetrics and Gynecology, 41: 855-859.

A CROSS-SECTIONAL STUDY OF GROWTH OF ALGERIAN CHILDREN FROM THE TELL AND THE AHAGGAR (SAHARA) M.C. Dop, R. Turc, E. Maiza, M. Keddari, P. Rochiccioli, A. Sevin and Ph. Lef~vre-Witier Clinique Medicale Infantile, CHU Mustapha, Algiers (Al(Algeria); Service de Pediatrie et de Genetique Medicale CHU Rangueil, Toulouse; Centre d'Hemotypologie du CNRS Toulouse (France) From 1977 to 1980 a Franco-Algerian collaborative population biology survey* was conducted in the Ahaggar region of the Sahara (country of Tamanrasset) (fig. 1). 488 nomadic and sedentary children from birth to 17 years of age were examined and measured. Concurrently, two groups of children from the Algerian Tell were studied, the first one of 220 children, 4 to 17 years of age, belonging to a scout pack in the city of Algiers, and the second comprising 204 school-age children from Tekteka, a rural village 30 miles southwest of Algiers. MATERIAL AND METHODS Body measurements were made, the clinical status was studied and various laboratory investigations were carried out on bloodurine, and stool samples. The ages of the children were obtained from birth certificates or school records. For some Saharan children the age was determined after thorough interrogation of the parents. Ages are given in completed years. This paper presents data on the height, weight and subscapular skinfold of 667 children 4 to 17 years of age**. Intergroup comparisons were made two by two because of the small size of the samples, using Student's t-test. *Commission Mixte Franco-Algerienne pour la Recherche Scientifique et Action Thematique Programmee, Dynamique des Populations, C.N.R.S. n° 2290. **Data on Saharan infants is not included because of the lack of comparative Algerian data. 139

M. C. DOP ET AL.

140

,--.•

.-,

I

"

.

·•• ·-. ....·


-l a

u... z

9

::,.,:: U)

0:: ~

-l

8

=> c... ~

w U)

l::Q

7

- ----

80Ul (CEAlliLA)

=> U)

6

,

5 • - - - - _I

4·5

6-7

,,

8-9

,,

1011

1213

14~5

16-17

AGE

Fig. 7. Subscapular Skinfold (Girls)

GROWTH OF ALGERIAN CHILDREN

151

Bouzina, we have likewise grouped the children in two year age groups. The boys from Algiers show the highest means. The Tekteka boys have a significantly lower value at la-II, the Tamanrasset boys at la-II and at 14-15 (Fig. 6a, 6b). In all age groups Bouzina boys have lower means than the Algiers group (p value under .01) (Fig. 6c). For the girls over II we do not have any data from Tamanrasset, Tekteka, or Bouzina. Under II the Tekteka girls have smaller means than the Algiers group at 6-7 and 8-9 (p = .001) (Fig. 7a). The Saharan girls at 8-9 only (p = .05) (Fig. 7a). The Bouzina girls have a thinner skinfold at 6-7 and 8-9 with a very small p value (Fig. 7b). The Bouzina and Tamanrasset girls do not differ significantly. DISCUSSION These results can be examined in an international context. Among the present study groups, the children from Algiers are nearest to the French standards of the International Children's Center published by Sempe (1979) for height, whereas the other samples show significantly lower values. The height of our 3 samples taken as a whole is comparable to that of Tunisian school children studied by Wachholder (1974) and by Artinian (1975). The rural Nigerian children measured by Oduntan (1974) are substantially smaller. Weight means of our samples are lower than the French standards. The means of the Algiers group are nearest to these standards but are nevertheless consistently lower. Weight means of our 3 samples taken as a whole are comparable to the above-mentioned Tunisian r~f­ erences. However, the Algiers children are somewhat heavier in most age groups. Rural Nigerians are lighter than our 3 samples taken as a whole. The subscapular skinfold of our samples is generally thinner than that of the French children, with the exception of the Algiers group, which has very similar values. We lack comparative African data for this measurement. CONCLUSION Three conclusions can be drawn from this study: - the height and weight of the urban and rural groups from the Tell are very similar. This finding reflects the favorable socio-economic situation of the rural environment in this region. The population of Tekteka is under good medical surveillance and although infectious and parasitic aggressions are intense, growth does not appear to be affected;

1982)

"

80uzina (Aures) (CHAMLA and DEMOULIN, 1976) n mean

0

Tamanrasset (Ahaggar) (TURC, 1982) n mean

0

Tekteka (Tell) (OOP, 1982) n mean

0

n mean

(HAlZA,

Algiers (Tell)

Age in years

12 12.29 2.18

4

IS 14.99 2.40

6 17.62 2.SI

5

29 17 .82 2.26

17 18.62 3.1

15 18.79 2.53

6 20.58 4.27

6

55 18.96 2.44

9 18.5 4.70

20.36 2.19

16

9 19.60 2.07

7

36 20.33 2.30

5 17.4 4.71

24 22.80 2.95

22.55 3.62

11

8

31 21.61 1.80

21.83 2.98

6

10 24.78 2.09

16 26.87 4.43

9

20 22.85 3.63

26.94 3,.02

J7

8 31.56 4.69

10

30 27.63 4.23

4 30.87 7.51

10 32.28 5.45

30.25 4.32

II

II

6 35.25 8.56

9 41. 78 5.29

13

15 9 29.8& 40.22 3.44 8.10 ----------.

9 35.39 9.5

10 32.7 4.67

12

7 47.93 11.45

14 16

17

._------------

6 50.33 8.26

15

Table 4: Weight of Girls of Algiers, Tekteka and Tamanrasset (in kg)

...

!!J » r

"tI

0

0

~

P

N

(JI

3.71 0.67

4.78 I. 51

mean

a

4.52 0.79

4.26 0.85

3.92 0.57

0.57

a

28

0.75

4.48

3.52

37

0.83

I. 36

51

4.46

4.53

27

mean

n

Bouzina (Aures) (CHAMLA and DEMOULIN, 1976) 56

19

14

n

24

I. 16

0.47

0.49

a

Tamanrasset (Ahaggar) (TURC, 1982)

4.17

4.07

21

6.02

2.23

32

6.80

13

12 - 13

6.00

24

10 - II

3.74

28

0.79

4.36

19

8 - 9

mean

n 36

I. 07

I. 44

a

Tekteka (Tell) (DOP, 1982)

4.10

17

6 - 7

4.70

9

4 - 5

mean

n

Algiers (Tell) (MAIZA, 1982)

Age in years

0.45

4.7

8

0.79

5. II

22

I. 84

6.61

16

14 - 15

0.80

5.28

13

I. 25

6.32

5

16 - 17

Table 5: Subscapular skinfold of boys of Algiers, Tekteka and Tamanrasset (in mm)

C)

:D

w

U1

m Z

:D

0

r

I

()

l> z

:D

m

C)

» r

"Tl

0

-l I

0 ~

24

(J

mean

n

4.15 0.91

0.98

12

2.05

4.81

8

4.4

22

0.57

0.97

(J

Bouzina (Aures) (CHAMLA and DEMOULIN, 1976)

4.67

4.71

mean

n 12

2.06

0.73

(J

Tamanrasset (Ahaggar) (TURC, 1982)

4.51

4.31

2.17

6

4

1. 33

5.24

5

1.51

5.25

27

3.64

2.69

2.11

34

8

19

12 - 13

6. IS

19

10 - I I

6.55

27

8 - 9

mean

n 32

2.11

2.07

(J

Tekteka (Tell) (DOP, 1982)

5.92

IS

6 - 7

5.32

8

4 - 5

mean

n

Algiers (Tell) (MAIZA, 1982)

Age in years

4.15

10.88

13

14 - IS

5.13

13.2

7

16 - 17

Table 6: Subscapular skinfold of girls of Algiers, Tekteka and Tamanrasset (in mm)

r

»

-I

m

"lJ

0

0

s:: n

~

Ul

GROWTH OF ALGERIAN CHILDREN

155

- the second observation, and the most interesting one, is the impaired growth of the children of Bouzina by comparison with the Algiers sample. The boys seem more affected than the girls. Socioeconomic factors obviously playa· role: Bouzina is a poor and isolated village, with no medical facility. But the population is also highly endogamous and the thalassemic trait is very prevalent; and - the Saharan children of the region of Tamanrasset, on the contrary, although living in harsh environmental conditions, attain growth levels only slightly inferior to those of the more privileged groups of the Tell. Interpretation of this observation is difficult since this sample covers in fact two distinct environments: the sedentaries, although enjoying good food supply and medical surveillance, are confronted with the consequences of the rapid and anarchic growth of the city of Tamanrasset, that is, overcrowded housing and high fecal risk due to the shortage of water and poor sanitation. The nomade, on the other hand, are poorer and far away from any medical facility, but are less exposed to transmissible diseases because of the low density of the population. The aim of the study is clearly not to provide standards for Algerian children, but to point out the great difficulties that will be encountered in the establishment of such standards. A wide range of environmental factors - i.e. geoclimatic and socio-economic prevails, and different genetic factors are present which may also, affect the growth patterns of Algerian children.

REFERENCES Artinian, K., Artinian, S., DOcov, Y., 1975, Developpement physique des e1eves Tunisiens, Tunisie Med., 53: 59-70. Cham1a, M.C., Demoulin, F., 1976, Croissance des algeriens de l'enfance a l'age adu1te (region de l'Aures). Editions du C.N.R.S. Laboratoire d'Anthropo10gie et de Prehistoire des Pays de la Mediterranee Occidentale, Paris, 167. Cou1anges, M.T., 1979, Croissance staturo-pondera1e de 1'enfant gabonais de 1a naissance a 1a onzieme annee. These Doc. Med., Toulouse, n° 617. Dop, M.C •., 1982, Tekteka: resultats d'une enqu~te biomedicale dans un village rural du Tell Algerien. These Doc. Med., Toulouse, n° 250. El Nofely, A.A., 1978, Anthropometric study of growth of Egyptian nubian children, Hum. Bio1., 50: 183-208. Kerimov, M.K., 1973, Physical development of school children in various areas of Daghestan (based on 1969-71 study data). Sovetskoe Zdravookhranemie, 32: 27-32 (in russian).

156

M. C. DOP ET AL.

Lefevre-Witier, Ph., Benabadji, M., 1979, Contraintes biologiques, contraintes culturelles au Sahara; action sur les structures de la population isseqqumarene (Hoggar - Algerie). Action thematique programmee - Dynamique des Populations. C.N.R.S. Contrat n° 2290. Rapport Scientifique, avril-mai, C.N.R.S.-O.N.R.S. 124. Maiza, E., Croissance et puberte d'un groupe d'enfants d'Alger. (Personal communication). Oduntan, S.A., 1974, The health of Nigerian children of school age (6-15 years). I: Design of the study, general appearance, heights and weights, nutritional status and haematological findings, Ann. Trop. Med. Parasitol., 68: 129-143. Sempe, M., Pedron, G., Roy-Pernot, M.P., 1979, Auxologie, methode et sequences, Laboratoire Theraplix, Paris, 205. Turc, R., 1982, Etude de la croissance d'enfants du Sahara algerien (Hoggar). These Doc. Med., Toulouse, nO 41. Wachholder, A., Beghin, D., Trabelsi, M., Cantraine, F., 1974, La taille et le poids des ecoliers du Cap Bon (Tunisie). Premieres donnees, Arch. lnst. Pasteur, Tunis, 3: 201-210.

GROWTH NORMS FOR BODY WEIGHT BY STATURE AND CHEST GIRTH IN 6 TO 12 YEAR-OLD CHILDREN M. Hebbelinck and J. Borms Laboratory of Human Biometry and Movement Analysis Vrije Universiteit Brussel, Belgium

It is a truism that each part of the body is related to another throughout every phase of human growth. Several authors have advocated prediction of body weight from stature and other body measurements, usually diameters or girths (Von Dobeln, 1959, Garn, 1962, Pryor, 1966, Luyken, Dewijn and Zaat, 1967). No such tables have been constructed for a Belgian school population. The present paper offers specific data obtained for the two sexes from the Dutch-speaking Belgian primary school population (age 6 tot 12 years). METHODS Sample 7,685 boys and 5,485 girls; aged 6 to 12 years; were measured anthropometrically during the years 1968 to 1971, based on a random sampling of primary schools as described earlier (Hebbelinck and Borms, 1978). Measurements Inspection of the inter correlation matrices of the various anthropometric variables showed that, besides stature, the highest correlations between body weight and other measures occurred with respect to chest girth (r varied between .77 and .90 for boys, and between .79 and .85 for girls). It was also shown that chest girth had a distinctly higher correlation with body weight than bicondylar femur width and slightly better than relaxed upper arm girth, which had the next highest correlations to chest girth. It was therefore decided to take chest girth and stature as predictors for body weight. 157

158

M. HEBBELINCK AND J. BORMS

Stature was measured with an anthropometric rod, the child standing upright with his legs closed, the head in the tragion-orbital plane at right angles to the long axis of the trunk. The anthropometer was placed in the median line contacting the upper back. Chest girth was measured with a steel millimeter tape at the level of the xiphosternal joint (infrastnale). The child stood in a natural upright position, with upper extremities relaxed and held slightly away from the sides of the body. The tape was passed around the thorax in a horizontal plane at the xiphosternal level and brought into contact with the skin. The reading made was the median midway normal respiration. Body weight was measured on a self-balancing scale. The subject was nude; except for shorts. RESULTS The multiple regression equations of height and chest girth with body weight for age and sex are given in table 1. The mUltiple correlation coefficients range from R = .87 to R = .94, yielding a common variance from 77.4 to 88.3 percent; this means that more than three quarters of the variability of body weight is to be ascribed to stature and chest girth. One of the aims of the study was to develop equations for estimating average body weight from easily accessible measurements. The prediction equations have been converted to simple form as two-dimensional tables (tables 2 and 3), representing normative values in terms of the 10th, 50th and 90th percentiles. Due to the greater range of the observed chest girth values in boys, this variable has been split up into a greater number of classintervals than for girls. ACKNOWLEDGEMENTS This study is a part of the research project 'Performance and Talent', an investigation supported by the Belgian Ministries of Culture (BLOSO and ADEPS), the Ministry of Health and Family (Centre of Studies on Population and Family), the Belgian Fund for Fundamental Collective Research (F.K.F.O.) and the Fund for Medical Scientific Research (F.G.W.O)

159

GROWTH NORMS FOR BODY WEIGHT

Table 1: Multiple regression equations, multiple R and standard error of estimate for 6 - 12 year old Flemish boys and girls (Performance and Talent 1968 - 1971) AGE

IIOYS

GIRl.S

6

WEIGHT

(x)

- kg)

F~OM

BODY HEIGHT (X Z - em) AND CIIlsr GIRTH (X) - eru)

X) .0.25X 2 + ll.SOX) - )6.7

R

~

0.88

SI)

(es t X)

~

) .)6

~

0.88

SD(est X)

~

) .40

X)

~

0.28X 2 + ll.S4X) - 43.4

R

8

X)

~

ll.29X Z + ll.S9X) - 46.7

R - 0.9)

SD

(est

X)

9

X) - 0.27X 2 + 0.76X) - 54. )

R • 0.91

SD(est

X)

0.J2X 2 + 0.84X) - 67.8

J. 46

1.6 )

R - 0.89

SD(est X) - 2.29

+ 0.76X) - 67.9

R • 0.9)

SD(est X) - l.) 9

0.32X 2 + 0.9SX J - 74.5

R • 0.94

SI)(est X)

X) • 0.2)X l + ll.S4X) - )5.6

R = 0.87

SD(~st

X) = 0.lSX 2 + 0.S7X) - 40.4

~

- 0.87

R

~

)0

X)

) )

X) = 0.)6X 2

)2

X)

6

-

~

~

ll.)OX l + ll.6llX)

0.89

SD(est X)

2.) 4

~

I. ) 9

~

) .56 ) .62

8

X)

9

X) = 0.29X o + 0.8)X) - 60.)

R • 0.88

SD(est X)

~

LOS

)0

X) - O. )OX 2 + 0.76X) - 57.8

R = 0.88

SD(est X)

~

2.38

))

X) - 0.)4X 2 + 0.83X 3 - 68.9

R

~

0.90

SD(est X)

~

2.58

)2

X) - 0.)4X 2 + 0.96X 3 - 77.6

R

~

0.90

SD(est

~

3.03

~

48.6

X)

m

SD(est

X)

X)

a:.~

•

1~.O

'~.'I

• !. '> -

u.~

1~.O

1$.0

2).0

... :,.~

~5.0

H.G

lo.)

H.G J$.5

n.5

)1.$

2~.~

n.~

U.1l

!'I.S

J•• 5

JIo,!>

" .. M.'

)9.~

)6.1,1

,... )1.)

,9.5

)J.o

~

.. u.~

)9.)

"..

,t.G

11.0

n.s

u ... 'f

U.5

.~

""., 51.S

50,I,l ~J.~

Table 2: Norms for body weight (kg) after stature (em) and ehest girth (em) - boys

0>

(f)

:0 ~

o

III

L

o

Z

l>

""

()

Z

r

m

III III

m

I

~

o

1(0."")11.\1

I'.~

I •. ~

H)

'I~.~

''J,O

11,)

u.\

,,, ... 2"~

n.o

19.\ ~M

2".0

110.0

!LO

111.\

l~".'

)).0

n .•

lJ.~

21o.~

H.1l JIl.II

lS.)

JJ.\

.... ..

n.s

....

"'

29.4.1

)9.~

JS.S

\0.0

U.S

lolo.S

JII.S

,•• s U.S

.. "'.\

u.s

"H.S " .. n.o

.:•• S

J9,\

)10.0

·a.s

11.\

....

u .•

109.0

....

U.O

Table 3: Norms for body weight (kg) after stature (em) and chest girth (em)

-

.'.0

1t:.0

girls

)0.\

Sl.S

NO

:D

c;)

Ol

I -i

G)

:E m

-
O.I) (Brandt, 1978; 1980b). If age is not corrected for prematurity, there is a significant difference between preterm and full-term infants; this amounts to 6.3 cm at regular term of birth (40 postmenstrual weeks) and decreases with increasing age and decreasing growth velocity to 0.4 cm at 18 months, and to 0.04 cm at 6 years. This "assimilation" of the non-age-corrected curve to that of the full-term controls is solely due to the rapid decrease in growth velocity of head circumference. From its peak of 4.3 cm/month in the 34th postmenstrual week velocity decreases to 0.04 cm at 4.5 years, i.e. to one-hundredth (Brandt, 1978). At term, 63% of adult head circumference has been achieved; by contrast, only 30% of height has been attained. At birth, mean head circumference amounts to 35.4 cm for boys and 34.6 cm for girls, a significant difference of 0.8 cm (p

...3...

'"'"2? 0

...z

5

... Z

.... '" 2?

.... 2?

VENEZUELA

Fig. \. Sex dimorphism of stature in some popUlations of Venezue la, Cuba, Belgium, England, The United States, the Netherlands and Norway.

Differences in sex average height of 4.9 between Caracas and Zulia and of 3.2 cm between Caracas and Portuguesa-Yaracuy were significant at the 5% level (Table 1), yet sex dimorphism is almost identical in the three populations. No significant differences appeared for any of the three variables (p

'"

12

0

9

lJ..

a:

w

(II

;:!;

::>

z

6 3 0

1.00

1.33

1.67

2 ,00

2 .33

2 ,67

3.00

3.33

3 .67

4 .00

Fig. I . Distribution of GYNDEX Scores for three decades postmenarche in maturity series sample (N = 54).

the intensity and duration of dysmenorrhea (see Gardner, 1982, for details) . RESULTS The frequency distribution of the GYNDEX for these women in each of the first three decades postmenarche are presented in Fig.l. The range of scores is consistent for the three decades; however, each subsequent decade the distribution becomes less skewed as more scores move to the middle of the range. The change in the indices of first decade postmenarche to the second decade postmenarche is significant at p

with

a

double

begins

the dorsal

::>1.Jnrdr

the plantar surrace

.)f

differentiated,

knob

rht'

I j ne.

to

forming

line and

form on

the

228

an tat

posterior

surface.

The center

shows

the dorsal

surface and the plantar surface;

a

marked

Dosterjar part of

the center

on

~an.

the

form

f)f

a

indentation

thickens

In

both

JJ5

258

the

taking

Table 4: Figures, descriptions and scores of the TALUS TALUS

A

B

The center fakes on a clearly elongated form.

~

1. The length of the center the width of the tibial

2.

The dorsal

is equal

or superior to

GIRLS

o

15

17

25

30

25

metaphysis.

border of the center

is concave

and a double line appears.

3. There is a central area than

which

is less dense

the borders.

An articular facet for the calcaneus appears

c~

BOYS

as an

indentation

a

defined more dense line,

well

in

the plantar surface with which gives

the bone its definitive form of a figure 8 (resting on

the calcaneus)

391

SKELETAL MATURITY OF THE ANKLE AND FOOT

Table 5: Figures, description and scores of the CUBOID CUBOID

BOYS The center is visib!! as a single or multiple

A

GIRLS

35

cluster of badly defined calcium deposits.

The appearance of the center is different, B O a continuous,

c

82

o

with

408

409

460

448

smooth border.

The maximum diameter of the center reaches the width of the inferior metaphysis of the fibula.

RESULTS AND DISCUSSION Multiple linear regression of anthropometric measurements with skeletal maturity resulted in a maximum correlation for weight and head circumference as shown in table 1. These two parameters hav.e a high coefficient of correlation in our children (r = 0,94). The equation of the factor estimated by factorial analysis was F = (0.701 X weight) + (0.7071 X head circumference). Multiple correlation coefficients of skeletal maturity with the factor were 0.92 for boys and 0.93 for girls. We have found multi-collinearity between stages of the same and different bones, one reason that explains the elimination of the above-mentioned nine stages. Statistical analyses for each age and sex group of maturity values of radiograms provided Gaussian distribution curves either directly or after applying a logarithmic approach to some age-groups for the first year (figures 1 and 2). Student's-statistical test comparing means of skeletal maturity between boys and girls gave significant differences (p;;"---_/

MLD(H-lsn STD(16-17Y) JUN(18-19Y) SEN( +20Y )

MLDQ

DRY LAND

QUANTITY (km/yr)

.31

PERFOR}!ANCE (score) 200 m

400 m

.59**

.79** -.28

-. 17

-.29

QUANTITY (hr/yr)

• IS

.33

.70**

INTENSITY (score)

.03

.20

.71**

INTENSITY (score)

534

L. VAN TILBORGH ET AL.

When all relevant variables, as they are used in the evaluation center, along with the other swimming strokes, have been taken into account, the analysis of individual follow-up can become more precise. ACKNOWLEDGEMENT We gratefully acknowledge the assistance of Dr. G. Beunen in determing the skeletal age of our subjects and of D. Verhetsel who was responsible for direct contact with and feedback to the coaches. REFERENCES Coen, G., 1978, 'Schwimmsportliche Leistungstabelle, Comparative performance tables', Godicke. Dixon, W.J., 1981, ed., 'BMDP Statistical Software', Univ. of California Press, Berkeley. Persyn, U., Hoeven, R., and Daly, D., 1979, An evaluation center for competitive swimmers, in: 'SwiumUng III', J. Terauds and W. Bedingfield, eds., Univ.:Park Press, Baltimore, 182-195. Persyn, U., Daly, D., Vervaecke, H., Van Tilborgh, L., and Verhetsel, D., 1982, Profiles of competitors using different patterns in the crawl events, in: 'Biomechanics and Medicine in Swimming', Human Kinetics Pub~, Champaign, (in press). Remington, R., and Schork, M., 1970, 'Statistics with Applications to the Biological and Health Sciences', Prentice Hall, Inc., Englewood Cliffs. Tanner, J.M., Whitehouse, R.H., and Healy, M.J.R., 1962, 'A new system for estimating skeletal maturity from hand and wrist, with standards derived from a study of 2600 British children: vol II: the scoring system', Int. Children's Center, Paris. Van Tilborgh, L., Daly, D., and Persyn, U., 1982, The influence of some somatic factors on passive drag; gravity and buoyancy forces in competitive swimmers, in: 'Biomechanics and Medicine in Swimming', Human Kinetics PubT:, Champaign, (in press). Vervaecks, H., and Persyn, U., 1981, Some differences between men and women in various factors which determine swimming performances, in: 'The female athlete', J. Borms, M. Hebbelinck and A. Venerando, eds., in: 'Medicine and Sport', Karger, Basel, 150-156.

NUTRITION, PHYSICAL WORK CAPACITY AND WORK OUTPUT

K. Satyanarayana, A. Nadamuni Naidu and B.S. Narasinga Rau National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, India It is generally believed that productivity among workers in developing countries is low. This has been attributed at least in part to their poor physique as a consequence of chronic malnutrition. Evidence based upon epidemiological data collected during wars and other conditions of deprivation have indicated that inadequacy of food intake results in reduced work efficiency and productivity (Anon., 1962). However, there is scant evidence for a relationship between nutrition and work output under ordinary working situations. From the practical point of view, the possible adverse effect of small body size among large segments of the Indian population - brought about by chronic undernutrition - on work output, may be important in the context of national productivity. Studies undertaken to examine this relationship are presented here. The relationship between nutritional status on the one hand and work capacity and work output in real-life situations on the other has been investigated in two situations: (a) Physical work capacity was investigated in adolescent boys with a known early childhood nutritional background, using a bicycle ergometer, and the wages earned were taken as those paid by farmers; and (b) Nutritional status and work output were investigated in life situations among industrial workers. Early nutrition, body size, work capacity and wages earned A longitudinal study on the growth, development and functional status of 1 .480 children from 23 villages in rural Hyderabad was initiated in 1965 and is still in progress. From among these, 96 boys of 14 to 17 years of age and with different nutritional backgrounds were selected with a view to obtaining data on their physical 535

536

K. SATYANARA Y ANA ET AL.

work capacity. At the time of this study, 151 boys were hired by farmers to work for them in their agricultural operations and paid wages which ranged from Rs. 0.50/day to Rs. 5.00/day (£ 0.03 to 0.30 per day). The growth status of these subjects at five years of age was known. Their physical work capacity was determined under standard conditions, using a magnetically braked bicycle ergometer. When they were cycling at a speed of 50 to 60 revolutions per minute against different levels of resistance, their heart rates were monitored by recording their electro-cardiographs. The subjects were allowed to pedal for a period of six minutes at each work load and the amount of work done by each individual at a heart rate of 170/ minute (i.e., PWC 170 kpm/minute) was read from individual graphs relating heart rate to work load. The subjects were graded into two major habitual physical activity groups. Physical work capacity values were related to anthropometric and other parameters and the work capacity status of different groups described below was also calculated to establish the inter-relationships. Wages earned were correlated with different parameters and the boys were divided into age and earning groups to reflect the composition and characteristics of the better-paid groups by the farmers. The total 723 boys covered in the longitudinal study were classified as belonging to one of the four nutritional groups based on the extent of deficit in height for age (as measured against Boston standards (Reeds and Stuart, 1959) at age 5. Those in group I (22%) were considered normal as they managed to cross the mean (2 S.D.) limit. Those in group IV (16.7%) with less than mean (4 S.D.) values for height at age 5 were considered severely growth retarded. Those children in between these extreme categories were considered to have mild (Group II = 31.3%) and moderate (Group III = 30%) growth retardation respectively. Group I boys - although designated 'normal' were 5 em shorter and 3 kg lighter than the 50th percentile Boston boys at 5 years of age. On the other hand, group IV boys were shorter by 22 cm and lighter by about 7 kg than their Boston counterparts. Group IV boys thus represent the lowest nutritional plane - with nearly 3 years' growth lag at age 5 - every 5th child in this group had suffered from either kwashiorkor or marasmus in their early life. It was observed that current height in a given age group (all groups) and height at 5 years (r = 0.69; pa:




Y:O.72 X +'.38

•

r=0.79

P:··~ d , " " , " ' 4

16

~

.;p;,./' ~ .

14

/

12

10

. 8

/.

/

JII/

?

?

'/

'/

'" '"

,,-

/

/

/

"

/

/

/

Faping

___ . . - _ -

-a --

Non-failing _ - ...... - - ...... - -

6

4

2

B

3

4

6

yr

Fig. 2. Weight of failing and n0n-failing males and NCHS 5th and IOth percentiles.

subjects are clearly differentiated after I year of age, and the differentiation stays generally constant through 7. Within nonfailing and failing eategories, males are relatively smaller, eompared to the standards, than are females. Fig, 5. presents the curves for the mean trieepts skinfold thiekness in failing and non-failing ehildren of each gender. Between birth and I year of age, as with length and weight, a gradual separation oecurs sueh that, at I year, the means of non-

589

SKELETAL MATURATION OF MEXICAN CHILDREN Beight/Length in em

10th

5th

110

100

90

80

70

Fail ing - ~- - - . - Non-failing

60

_

~

_ __ •

__

j'

50

,,~

~

t

Fig. 3. Height of failing and non-failing females compared to 5th and 10th percentiles for NCHS reference standards.

failing children are greater than those of failing subjects, regardless of sex. This pattern is maintained until 3 years of age; however, from 4 through 7, the mean triceps values for failing females become larger than those of either of the two male groups. Furthermore, failing females actually have thicker mean thicknesses at 6 and 7 years than do non-failing females. In all four groups, the mean triceps skinfold reaches a maximum value at 5, declining thereafter through the end of our age range. In Fig. 6. we may see the graphs of the mean upper arm muscle area, expressed in squared centimeters, for the four groups. It is clear that mild-to-moderate protein-energy malnutrition is not associated significantly with a decrease in muscle mass. While males

590

F. E. JOHNSTON ET AL.

Heiabt/Length in em 10th 5th 110

100

90

80

-- ...... --

Failing

70

Non-failing

.... --

__ .... __ .... _

60

50

40

B

2

4

5

6

yr

Fig. 4. Height/length of failing and non-failing males and NCHS 5th and 10th percentiles.

and females are separated clearly from birth, there is no such separation by nutritional status. Table I shows the mean Greulich-Pyle skeletal ages from 4 through 7 years in failing and non-failing subjects, by sex. Even though failing children have lower skeletal ages than their nonfailing age and sex peers, the differences are not significant statistically. At the same time, the skeletal ages of all age sex and nutritional status groups are considerably below the reference standards. For example, at 48 months of age (i.e., 4 years), the mean skeletal ages of our subjects range from 25.7 through 30.5 months of age, a delay of approximately 40%.

591

SKELETAL MATURATION OF MEXICAN CHILDREN

11

Triceps skinfo1d

:0

m

Z

Z

:0

m

-i -i

"U }>

G)

Z

m m 0

'TI

608

o. NEYZI ET Al.

the trend towards obesity in group 1 was already present prior to supplementation. These findings indicate that obesity reported in formula-fed groups is probably related to irrational feeding habits with no frequent weight surveillance. Others have also shown that weight and height gains in the breast-fed infant may be comparable to or higher than formula-fed groups (Sveger et al., 1973; Oakley, 1977). The results indicate that the difference between breast-fed and formula-fed girls was more pronounced than that observed between group 1 and group 2 boys. The figures in tables 3 and 4 show that, in many age groups, the proportion of obesity among formula-fed boys was higher than that of formula-fed girls. Although the whole group of subjects consisted of infants and children of relatively well-educated parents from a high socioeconomic class, it was still considered possible to interpret this finding as the result of a traditional differential attitude towards boys on the part of the parents. The findings also indicate that differences due to feeding regimens exist in the first two or three years of life and have no impact after age three. SUMMARY A retrospective analysis was carried out to investigate the relationship between type of diet in early infancy and excess weight or obesity. Ponderal index and relative weight values were calculated using weight and height measurements from a group of healthy infants and children who had been followed longitudinally from birth to 5 years of age. Group 1 consisted of subjects who had been fed solely on breast milk in the first 3 months of life. Infants fed on formula or formula in addition to breast milk constituted group 2. When ponderal index was taken as the criterion, the overall proportion of obesity in both boys and girls in group 1 was found to vary between 0.02 and 0.03 and the proportion of the obese + overweight group between 0.08 and 0.30. In group 2, these proportion varied between 0.006 and 0.02 for obesity and between 0.06-0.18 for overweight + obese. When the same analysis was performed taking relative weight values as an index, the frequency of obese subjects in group 1 varied between 0.001 and 0.04 and that of the overweight + obese group between 0.04 and 0.25. In group 2, these values ware 0.005-0.02 and 0.03-0.21 respectively. These results show that overall frequency of obesity or of excess weight was not high in the formula-fed group. The proportion of excess weight (overweight + obese) was consistently higher in the breast-fed group after the first three months of life, significantly so in the girls.

0.24

0.49

0.74

0.99

1.99

2.99

3.99

4.99

0.00

0.25

0.50

0.75

1.00

2.00

3.00

4.00

AGES (decimal year)

0.14

0.1.9

0.10

0.25

0.30

0.25

0.14

poisson

0.15

N.S.

0.16

N.S.

N.S.

p < 0.05 0.06 poisson

N.S.

N.S.

N.S.

P < 0.05

N.S.

£

0.13

0.08

0.22

N.S.

0.18

N.S.

0.21

P < 0.01

0.14

0.18

0.11

0.20

P < 0.05

0.16

0.13

0.15

0.17

Group 2

BOYS (obese+overweight)

0.19

0.18

0.12

P < 0.01

0.11

Group 1

0.23

N.S.

£

N.S.

0.12

0.14

0.16

0.17

Group 2

Group 1

GIRLS (obese+overweight)

Table 3: Proportions of overweight + obese subjects by PI criterion in girls and boys of Group 1 and 2

-


FEEDING PATTERN IN EARLY INFANCY

611

REFERENCES Belton, N.R., Cockburn, F., Forfar, J.O., Gles, M.M., Kirkwood, J., Smith, J., Thistlethwaite, D., Turner, T.L., and Wilkinson, E. M., 1977, Clinical and biochemical assessment of a modified evaporated milk for infant feeding, Arch. Dis. Child., 52: 167. Bernal, J., and Richards, M.P.M., 1970, The effects of bottle and breast feeding of infant development, J. Psychosomat. Res., 14: 274. Charney, 0., Goodman, H.C., McBride, M., Lyon, B., and Pratti, R., 1976, Childhood antecedents of adult obesity, Do chubby infants become obese adults ?, N. Engl. J. Med., 295: 6. Ferris, A.G., Loos, M.J., Hosmer, D.W., Beal, V.A., 1980, The effect of diet on weight gain in infancy, J. Clin. Nutr., 33: 2635. Fomon, S.J., 1974, 'Infant Nutrition', 2nd ed., W.B. Saunders Co., Philadelphia. Johnston, F.E., 1978, Somatic growth of the infant and preschool child in 'Human Growth' vol 2, F. Falkner and J.M. Tanner, eds., Bailliere-Tindall, London, p. 91. Mellander, 0., Vahlquist, B., Mellbin, T., and collaborators, 1959, Breast feeding and artificial feeding, Acta. Paediatr. Scand., suppl. 116, chapter VII. Neyzi, 0., Yalcindag, A., and Alp, H., 1973, Heights and Weights of Turkish children, J. Trop. Pediat., 19: 5. Neyzi, 0., Saner, G., Alp, H., Binyildiz, P., Yazicioglu, S., Emre, S., Gurson, C.T., 1976, Relationship between body weight in infancy and weight in later childhood and adolescence. The adipose child, Paediat. Adolesc. Endocr., I: 89. Neyzi, 0., Binyildiz, P., Alp, H., 1979, Growth standards for Turkish children: Heights and weights, Courrier, 29: 553. Oakley, J.R., 1977, Differences in subcutaneous fat in breast- and formula-fed infants, Arch. Dis. Child., 52: 79. Poskitt, E.M.E., and Cole, J.J., 1977, Do fat babies stay fat ?, Br. Med • J., I: 7. Shukla, A., Forsyth, H.A., Anderson, C.M., Marnan, S.M., 1972, Infantile overnutrition in the first year of life, A field study in Dudley Worcestershire, Br. Med. J., 4: 507. Steward, A., and Westropp, C., 1953, Breast feeding in the Oxford child health survey, Part II., Comparison of bottle-and breastfed babies, Br. Med. J., 2: 305. Sveger, T., Lindberg, T., Weibull, B., Olssan, U.L., 1973, Nutrition, overnutrition and obesity in the first year of life in Malmo, Sweden, Acta. Paediat., 64: 635.

GROWTH IN CHILDREN WITH DIABETES

T.J. Lee, S. Stewart-Brown, J. Wadsworth and D.C.L. Savage The Bristol Royal Hospital for Sick Children St. Michael's Hill, Bristol, England

INTRODUCTION There is confusion in the literature concerning the quality of growth in children with diabetes. We have been aware that a number of our children have grown poorly and, for this reason, we have monitored the growth of all our newly diagnosed diabetic patients. METHOD All children, attending our clinic for the first time between 1975 and 1981, were measured at each visit by trained nursing staff using a Harpenden stadiometer. From this data we calculated: (a) Height standard deviation (SD) score at diagnosis. (b) Height SD scores at annual intervals from diagnosis. (c) Height velocity SD scores. Height velocity SD scores can be calculated using'charts prepared from data derived from: (1) Prepubertal children (girls under 6.75 years and boys under 8.75 years). (2) Pubertal children for whom a peak height velocity can be calculated. The time of this peak has been 'centered' to enable SD scores to be derived. It was not possible to calculate SD scores on a number of the height velocity values we had obtained as many of the children were too old for the prepurbertal charts and had not reached their peak height velocity. To overcome this difficulty we extended the prepubertal charts where we knew that a child was still, clinically, prepubertal. The mean value for height velocity was obtained by continuing the deceleration of the 50th centile line on the Tanner 613

T. J. LEE ET AL.

614

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where (6T) is the diagonal matrix of order n-I with elements 6t l , ... , 6t n _ l . The matrix H is the matrix of order n with elements h . . = -I 1 1 and h . . 1 = 1 (i=l, n-I); h = -I' h = I, all other elements . 1.~1+ n,n-I ' n,n be1ng 0 1 if a. < 0 1 if a. = 0 1 if a. = 0 1 ~

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54 weekly weighings of a child were obtained from age 32 weeks. A quadratic trend identified by sequential fitting was removed and the periodogram of the residuals obtained. Figure 1 shows the periodogram with 3 clearly distinctive peaks at about 2.4 and 6 cycles per year (rounded values for 1.93, 3.85 and 5.78) and a possible fourth one at the frequency 11 (10.59) cycles per year. Only the first 3 peaks are retained as significant. These first 3 harmonics of the fundamental frequency 2 cycles per year (period = 26 weeks or 6 months) indicate the nonsinusoidal character of the main cyclical component. With such a relative short length serial data the maximum period that can be obtained is 26 weeks. In fig. 2 the

810

T. HOANG AND V. PARSONS I-'J~

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cumulative periodograms of the residuals are plotted. With the polynomial fit a clear deviation from the diagonal (1,1) at the frequency 2 cycles per year is seen. With the polynomial and harmonic fit no large systematic deviation is left. The least squares estimate of the parameters are displayed in Table I. None of the coefficients b. of the sine waves are significant implying that the phases ';'1' 4>2 akd ~3 do not differ significantly from O. Thus the amplitudes do not differ significantly from ai' a 2 and a 3 .

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53

Corrected Total

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