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Objective:
The Indonesia Basic Health Research 2018 indicates that Indonesian children are still among the shortest in the world. When referred to World Health Organization Child Growth Standards (WHOCGS), the prevalence of stunting reaches up to 43% in several Indonesian districts. Indonesian National Growth Reference Charts (INGRC) were established in order to better distinguish between healthy short children and children with growth disorders. We analyzed height and weight measurements of healthy Indonesian children using INGRC and WHOCGS.
Methods:
6972 boys and 5800 girls (n = 12,772), aged 0-59 months old, from Bandung District were measured. Z-scores of length/height and body mass index were calculated based on INGRC and WHOCGS.
Results:
Under 5-year-old Indonesian children raised in Bandung are short and slim. Mean height z-scores of boys is -2.03 [standard deviation (SD) 1.31], mean height z-scores of girls is -2.03 (SD 1.31) when referred to WHOCGS indicating that over 50 % of these children are stunted. Bandung children are heterogeneous, with substantial subpopulations of tall children. Depending on the growth reference used, between 9% and 15% of them are wasted. Wasted children are on average half a SD taller than their peers.
Conclusion:
WHOCGS seriously overestimates the true prevalence of undernutrition in Indonesian children. The present investigation fails to support evidence of undernutrition at a prevalence similar to the over 50% prevalence of stunting (WHOCGS) versus 13.3% (INGRC). We suggest refraining from using WHOCGS, and instead applying INGRC that closely mirror height and weight increments in Bandung children. INGRC appear superior for practical and clinical purposes, such as detecting growth and developmental disorders.
Meeting Reports
(2019)
Thirty-one scientists met at Aschauhof, Germany to discuss the role of beliefs and self-perception on body size. In view of apparent growth stimulatory effects of dominance within the social group that is observed in social mammals, they discussed various aspects of competitive growth strategies and growth adjustments. Presentations included new data from Indonesia, a cohort-based prospective study from Merida, Yucatan, and evidence from recent meta-analyses and patterns of growth in the socially deprived. The effects of stress experienced during pregnancy and adverse childhood events were discussed, as well as obesity in school children, with emphasis on problems when using z-scores in extremely obese children. Aspects were presented on body image in African-American women, and body perception and the disappointments of menopause in view of feelings of attractiveness in different populations. Secular trends in height were presented, including short views on so called 'racial types' vs bio-plasticity, and historic data on early-life nutritional status and later-life socioeconomic outcomes during the Dutch potato famine. New tools for describing body proportions in patients with variable degrees of phocomelia were presented along with electronic growth charts. Bio-statisticians discussed the influence of randomness, community and network structures, and presented novel tools and methods for analyzing social network data.
Stunting
(2021)
Growth and body height have always been topics interesting to the public. In particular, the stupendous increase of some 15-19 cm in final adult height during the last 150 years in most European countries (the "secular trend"), the concomitant changes in body and head proportions, the tendency towards early onset of sexual maturation, the changes in the age when final height is being reached, and the very recent trend in body mass index, have generated much scientific literature. The marked plasticity of growth in height and weight over time causes problems. Child growth references differ between nations, they tend to quickly become out of date, and raise a number of questions regarding fitting methods, effects caused by selective drop-out, etc. New findings contradict common beliefs about the primary importance of nutritional and health related factors for secular changes in growth. There appears to be a broad age span from mid-childhood to early adolescence that is characterised by a peculiar insusceptibility. Environmental factors that are known to influence growth during this age span appear to have only little or no impact on final height. Major re- arrangements in height occur at an age when puberty has almost been completed and final height has almost been reached, implying that factors, which drive the secular trend in height, are limited to early childhood and late adolescence.
The aim of this methodological anthropometric study was to compare direct anthropometry and digital two- dimensional photogrammetry in 18 male and 27 female subjects, aged 24 to 65 years, from Potsdam, Germany. In view of the rising interest in reliable biometric kephalofacial data, we focussed on head and face measurements. Out of 34 classic facial anatomical landmarks, 27 landmarks were investigated both by direct anthropometry and 2D-photogrammetry; 7 landmarks could not be localized by 2D-photogrammetry. Twenty-six kephalofacial distances were analysed both by direct anthropometry and digital 2D-photogrammetry. Kephalofacial distances are on average 7.6% shorter when obtained by direct anthropometry. The difference between the two techniques is particularly evident in total head height (vertex-gnathion) due to the fact that vertex is usually covered by hair and escapes from photogrammetry. Also the distances photographic sellion-gnathion (1.3 cm, i. e. 11.6%) and nasal-gnathion (1.2 cm, i. e. 9.4%) differ by more than one centimetre. Differences below 0.5 cm between the two techniques were found when measuring mucosa-lip-height (2.2%), gonia (3.0%), glabella-stomion (3.9%), and nose height (glabella-subnasal) (4.0%). Only the estimates of forehead width were significantly narrower when obtained by 2D-photogrammetry (-1.4 cm, -13.1%). The methodological differences increased with increasing magnitude of the kephalometric distance. Apart from these limitations, both techniques are similarly valid and may replace each other.
Ample literature describes the history of the association between the advances in the health and wealth of people, and mortality rates, life expectancy and adult height. Twentynine German studies with n > 200 subjects published since 1848 on menarcheal age, were reanalyzed, and 101 studies from various other European and non-European countries. On average, mean age at menarche declined since the mid-19(th) century. Historic urban samples tended to decline earlier than rural groups, upper class women earlier than working class women. In Germany, minimum values for the age at menarche were seen already between the two World Wars (Leipzig 12.6 years in 1934, Halle 13.3 years in 1939). Values for mean age and SD for age at menarche were strongly associated. With improving historic circumstances, the two parameters declined in parallel. The standard deviation for menarcheal age dropped from over 2.5 years in mid-19th century France to little more or even less than 1 year in most modern countries. In the German studies the correlation between menarcheal age and SD was almost complete with r = 0.96 (y = 0.35x - 3.53). Similar associations between mean age at menarche and SD for age were found in other European countries. The obvious and immediate effects of historic events on menarcheal age, and particularly on the age distribution, indicate that menarche is a sensitive indicator of public health and wealth, and may be an appropriate estimator for the socio-economic background of historic populations.
Recent progress in modelling individual growth has been achieved by combining the principal component analysis and the maximum likelihood principle. This combination models growth even in incomplete sets of data and in data obtained at irregular intervals. We re-analysed late 18th century longitudinal growth of German boys from the boarding school Carlsschule in Stuttgart. The boys aged 6-23 years, were measured at irregular 3-12 monthly intervals during the period 1771-1793. At the age of 18 years, mean height was 1652 mm, but height variation was large. The shortest boy reached 1474 mm, the tallest 1826 mm. Measured height closely paralleled modelled height, with mean difference of 4 mm, SD 7 mm. Seasonal height variation was found. Low growth rates occurred in spring and high growth rates in summer and autumn. The present study demonstrates that combining the principal component analysis and the maximum likelihood principle enables growth modelling in historic height data also.
Background: Human populations differ in height. Recent evidence suggests that social networks play an important role in the regulation of adolescent growth and adult height. We further investigated the effect of physical connectedness on height.
Material and methods: We considered Switzerland as a geographic network with 169 nodes (district capitals) and 335 edges (connecting roads) and studied effects of connectedness on height in Swiss conscript from 1884-1891, 1908-1910, and 2004-2009. We also created exponential-family random graph models to separate possible unspecific effects of geographic vicinity.
Results: In 1884-1891, in 1908-1910, and in 2004-2009, 1st, 2nd and 3rd order neighboring districts significantly correlate in height (p<0.01). The correlations depend on the order of connectedness, they decline with increasing distance. Short stature districts tend to have short, tall stature districts tend to have tall neighbors. Random network analyses suggest direct road effects on height. Whereas in 1884-1891, direct road effects were only visible between 1st order neighbors, direct road effects extended to 2nd and 3rd in 1908-1910, and in 2004-2009, also to 4th order neighbors, and might reflect historic improvements in transportation. The spatial correlations did not significantly change when height was controlled for goiter (1884-1889) and for median per capita income (2006), suggesting direct road effects also in goiter-allowed-for height and income-allowed-for height.
Conclusion: Height in a district depends on height of physically connected neighboring districts. The association decreases with increasing distance in the net. The present data suggest that people can be short because their neighbors are short; or tall because their neighbors are tall (community effect on growth). Psycho-biological effects seem to control growth and development within communities that go far beyond our current understanding of growth regulation.
Objective: The age of menarche is usually considered to be affected by nutritional, health-related, social, and economic factors and has significantly decreased since the mid-19th century. The present study was performed to investigate whether the timing of menarche paralleled the general acceleration of physical development, or whether this pattern differed.
Study Design: In all, 30 German studies on menarcheal age (n = > 200) since 1848 were collected. Frequency distributions were analyzed.
Results: During the second half of the 19th and the early 20th century, mean menarcheal age decreased from 18 to 12-13 years in Europe. Yet, the data fail to support the conventional hypothesis that menarcheal age mainly depends on nutritional, health, and economic factors.
Conclusions: We suggest that later than usual menarche may not necessarily be regarded as a physical illness, but in view of the apparently physiological delay of menarche in the 19th century, may be viewed as "collective social amenorrhea."
Target Audience: Obstetricians & Gynecologists and Family Physicians.
Learning Objectives: After participating in this CME activity, physicians should be better able to evaluate menarche as an indicator of developmental tempo in both historical and modern settings, compare menarche in healthy mid-19th century girls with menarche in average modern girls, and assess the marked sensitivity of full pubertal development to environmental circumstances.
Objectives: Modern human life style has led to significant decrease in everyday physical activity and bipedal locomotion. It has previously been shown that skeletal robustness (relative elbow breadth) is associated with daily step counts. The aim of the study was to investigate whether also other skeletal measures, particularly pelvic breadth may have changed in recent decades.
Methods: We re-analyzed elbow breadth, pelvic breadth (bicristal), and thoracic depth and breadth, of up to 28,975 healthy females and 28,288 healthy males aged 3-18 years from cross-sectional anthropological surveys performed between 1980 and 2012 by the Universities of Potsdam and Berlin, Germany.
Results: Relative elbow breadth (Frame index) significantly decreased in both sexes since 1980 (< 0.001). The trend toward slighter built was even more pronounced in absolute and relative pelvic breadth. In contrast, equivalent changes of parts of the skeletal system that are not involved in bipedal locomotion such as thoracic breadth, thoracic depth, and the thoracic index were absent.
Conclusions: The present investigation confirms the decline in relative elbow breadth in recent decades. Analogue, but even more pronounced changes were detected in pelvic breadth that coincides with the modern decline in upright locomotion. The findings underscore the phenotypic plasticity of humans while adapting to new environmental conditions. (C) 2014Wiley Periodicals, Inc.
Auxology has developed from mere describing child and adolescent growth into a vivid and interdisciplinary research area encompassing human biologists, physicians, social scientists, economists and biostatisticians. The meeting illustrated the diversity in auxology, with the various social, medical, biological and biostatistical aspects in studies on child growth and development.
Aim Growth is both a matter of amplitude and tempo. We aimed to develop references for body height, body weight and body mass index (BMI) with respect to tempo of maturity. Methods Data obtained from the German KiGGS study (2003-2006) on body height, body weight and presence or absence of the menarche were re-analysed in 3776 girls, aged 10-17years. We developed smoothed centiles for BMI-, body-height- and body-weight-for-age using the LMS method for premenarcheal and postmenarcheal girls. Results Body height, body weight and BMI differed significantly between premenarcheal and postmenarcheal girls. On average, postmenarcheal girls aged 11-17years were 5.3cm taller and 9.7kg heavier, and their BMI was 2.9kg/m2 higher than in premenarcheal girls of the same calendar age. Conclusion Adolescent BMI rises with calendar age and biological age. New reference charts for adolescent girls aged 10-18years were generated to be inserted into the currently used references to avoid misclassifying underweight and overweight pubertal girls.
Sexuelle Reifeentwicklung & Menarchealter : Bedeutung des psychosozialen Umfeldes damals und heute
(2012)
Height and skeletal morphology strongly relate to life style. Parallel to the decrease in physical activity and locomotion, modern people are slimmer in skeletal proportions. In German children and adolescents, elbow breadth and particularly relative pelvic breadth (50th centile of bicristal distance divided by body height) have significantly decreased in recent years. Even more evident than the changes in pelvic morphology are the rapid changes in body height in most modern countries since the end-19th and particularly since the mid-20th century. Modern Japanese mature earlier; the age at take-off (ATO, the age at which the adolescent growth spurt starts) decreases, and they are taller at all ages. Preece-Baines modelling of six national samples of Japanese children and adolescents, surveyed between 1955 and 2000, shows that this gain in height is largely an adolescent trend, whereas height at take-off (HTO) increased by less than 3 cm since 1955; adolescent growth (height gain between ATO and adult age) increased by 6 cm. The effect of globalization on the modern post-war Japanese society ("community effect in height") on adolescent growth is discussed.
Twenty-four scientists met at Aschauhof, Altenhof, Germany, to discuss the associations between child growth and development, and nutrition, health, environment and psychology. Meta-analyses of body height, height variability and household inequality, in historic and modern growth studies published since 1794, highlighting the enormously flexible patterns of child and adolescent height and weight increments throughout history which do not only depend on genetics, prenatal development, nutrition, health, and economic circumstances, but reflect social interactions. A Quality of Life in Short Stature Youth Questionnaire was presented to cross-culturally assess health-related quality of life in children. Changes of child body proportions in recent history, the relation between height and longevity in historic Dutch samples and also measures of body height in skeletal remains belonged to the topics of this meeting. Bayesian approaches and Monte Carlo simulations offer new statistical tools for the study of human growth.
Background: There is a common perception that tall stature results in social dominance. Evidence in meerkats suggests that social dominance itself may be a strong stimulus for growth. Relative size serves as the signal for individuals to induce strategic growth adjustments. Aim: We construct a thought experiment to explore the potential consequences of the question: is stature a social signal also in humans? We hypothesize that (1) upward trends in height in the lower social strata are perceived as social challenges yielding similar though attenuated upward trends in the dominant strata, and that (2) democratization, but also periods of political turmoil that facilitate upward mobility of the lower strata, are accompanied by upward trends in height. Material and methods: We reanalyzed large sets of height data of European conscripts born between 1856-1860 and 1976-1980; and annual data of German military conscripts, born between 1965 and 1985, with information on height and school education. Results: Taller stature is associated with higher socioeconomic status. Historic populations show larger height differences between social strata that tend to diminish in the more recent populations. German height data suggest that both democratization, and periods of political turmoil facilitating upward mobility of the lower social strata are accompanied by a general upward height spiral that captures the whole population. Discussion: We consider stature as a signal. Nutrition, health, general living conditions and care giving are essential prerequisites for growth, yet not to maximize stature, but to allow for its function as a lifelong social signal. Considering stature as a social signal provides an elegant explanation of the rapid height adjustments observed in migrants, of the hitherto unexplained clustering of body height in modern and historic cohorts of military conscripts, and of the parallelism between changes in political conditions, and secular trends in adult human height since the 19th century.
BACKGROUND/OBJECTIVES: We studied the association of body weight and weight variability among populations from different geographic, historic and socioeconomic background. SUBJECTS/METHODS: We reanalyzed data from 833 growth studies of 78 different countries from 1920 to 2013. We used data from two age groups-infants (age 2 years) and juvenile (age 7 years)-and divided the studies into two geographic-socioeconomic groups. RESULTS: Multiple regressions showed significant interactions between weight, sex, historic year of study, continent and within-study standard deviation. Multiple regression revealed R-2 = 0.256 (P<0.001) at age 2 years and R-2 = 0.478 (P<0.001) at age 7 years. Although infants and juveniles in more affluent countries are heavier than children in less affluent countries (P<0.001), the within-study standard deviation of the two geographic-socioeconomic groups differs at age 7 years (P<0.001) but not at age 2 years (P>0.15). CONCLUSIONS: The general impression that prosperous conditions lead to growth improvements in height and weight appears to be true only at a large scale: wealthy countries have tall and heavy children. At small scale, the situation is different. Whereas economic and nutritional improvements can exhibit substantial effects in weight gains, the discrepancy between the within-population variation in height and weight strongly suggests that height gains and weight gains are subject to different regulations.