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What does stunting tell us?
(2023)
Stunting is commonly linked with undernutrition. Yet, already after World War I, German pediatricians questioned this link and stated that no association exists between nutrition and height. Recent analyses within different populations of Low- and middle-income countries with high rates of stunted children failed to support the assumption that stunted children have a low BMI and skinfold sickness as signs of severe caloric deficiency. So, stunting is not a synonym of malnutrition. Parental education level has a positive influence on body height in stunted populations, e.g., in India and in Indonesia. Socially disadvantaged children tend to be shorter and lighter than children from affluent families.
Humans are social mammals; they regulate growth similar to other social mammals. Also in humans, body height is strongly associated with the position within the social hierarchy, reflecting the personal and group-specific social, economic, political, and emotional environment. These non-nutritional impact factors on growth are summarized by the concept of SEPE (Social-Economic-Political-Emotional) factors. SEPE reflects on prestige, dominance-subordination, social identity, and ego motivation of individuals and social groups.
Background
Subjective Social Status is used as an important predictor for psychological and physiological findings, most commonly measured with the MacArthur Scale (Ladder Test). Previous studies have shown that this test fits better in Western cultures. The idea of a social ladder itself and ranking oneself “higher” or “lower” is a concept that accords to the Western thinking.
Objectives
We hypothesize that in a culture where only the elites have adapted to a Western lifestyle, the test results reflect a higher level of accuracy for this stratum. We also expect that self-perception differs per sex.
Sample and Methods
We implemented the Ladder Test in a study of Indonesian schoolchildren aged between 5 and 13 years (boys N = 369, girls N= 364) from non-private and private schools in Kupang in 2020.
Results
Our analysis showed that the Ladder Test results were according to the Western expectations only for the private school, as the Ladder Scores significantly decreased with age (LM: p = 0.04). The Ladder Test results are best explained by “Education Father” for the non-private school pupils (p = 0.01) and all boys (p = 0.04), by “School Grades” for the private school cohort (p = 0.06) and by “Household Score” for girls (p =0.09).
Conclusion
This finding indicates that the concept of ranking oneself “high” or “low” on a social ladder is strongly implicated with Western ideas. A ladder implies social movement by “climbing” up or down. According to that, reflection of self-perception is influenced by culture.
Background In view of the ongoing debate on "chronic malnutrition" and the concept of "stunting" as "a better measure than underweight of the cumulative effects of undernutrition and infection (WHO)", we translate, briefly comment and republish three seminal historic papers on catch-up growth following re-feeding after severe food restriction of German children during and after World War I. The observations were published in 1920 and 1922, and appear to be of particular interest to the modern nutritionist. Results The papers of Abderhalden (1920) and Bloch (1920) describe German children of all social strata who were born shortly before World War I, and raised in apparently "normal" families. After severe long-standing undernutrition, they participated in an international charity program. They experienced exceptional catch-up growth in height of 3-5 cm within 6-8 weeks. Goldstein (1922) observed 512 orphans and children from underprivileged families. Goldstein described very different growth patterns. These children were much shorter (mean height between -2.0 and -2.8 SDS, modern WHO reference). They mostly failed to catch-up in height, but tended to excessively increase in weight particularly during adolescence.
Trends in growth and developmental tempo in boys aged 7 to 18 years between 1966 and 2012 in Poland
(2020)
Objectives:
To assess trends in growth in different developmental periods and trends in developmental tempo in Polish boys between 1966 and 2012.
Methods:
Data on 34 828 boys aged 7 to 18 years were collected during Polish Anthropological Surveys conducted in 1966, 1978, 1988, and 2012. Biological parameters, related to onset of adolescent growth spurt (OGS) and peak height velocity (PHV), were derived from a Preece-Baines 1 model (PB1). Childhood (height at 7 years of age), pre-adolescent (height at OGS) and adolescent growth (adult height minus height at OGS) were identified.
Results:
Positive secular trend between 1966 and 2012 in adult height accounted for, on average, 1.5 cm/decade, with varying intensity between the Surveys. Decline in both age at OGS and APHV between 1966 and 2012 (1.5 and 1.4 years, respectively) indicated an acceleration in developmental tempo, on average, by 0.3 year/decade. Increases in the contribution to the trend in adult height gained during growth in particular developmental periods between 1966 and 2012 were as followed-childhood: 0.6%, pre-adolescent growth: -3.1%, adolescent growth: 3.1%.
Conclusions:
Secular trend in developmental tempo and growth among boys reflects changes in living conditions and socio-political aspirations in Poland during nearly 50 years. Acceleration in tempo is already visible at age at OGS, whereas the trend in adult height occurs largely during adolescence, pointing to different regulation of developmental tempo and growth in body height. This finding emphasizes the importance of extending public health intervention into children's growth up until adolescence.
Life history theory predicts that experiencing stress during the early period of life will result in accelerated growth and earlier maturation. Indeed, animal and some human studies documented a faster pace of growth in the offspring of stressed mothers. Recent advances in epigenetics suggest that the effects of early developmental stress might be passed across the generations. However, evidence for such intergenerational transmission is scarce, at least in humans. Here we report the results of the study investigating the association between childhood trauma in mothers and physical growth in their children during the first months of life. Anthropometric and psychological data were collected from 99 mothers and their exclusively breastfed children at the age of 5 months. The mothers completed the Early Life Stress Questionnaire to assess childhood trauma. The questionnaire includes questions about the most traumatic events that they had experienced before the age of 12 years. Infant growth was evaluated based on the anthropometric measurements of weight, length, and head circumference. Also, to control for the size of maternal investment, the composition of breast milk samples taken at the time of infant anthropometric measurements was investigated. The children of mothers with higher early life stress tended to have higher weight and bigger head circumference. The association between infant anthropometrics and early maternal stress was not affected by breast milk composition, suggesting that the effect of maternal stress on infant growth was independent of the size of maternal investment. Our results demonstrate that early maternal trauma may affect the pace of growth in the offspring and, in consequence, lead to a faster life history strategy. This effect might be explained via changes in offspring epigenetics.
Aim Growth is a multifarious phenomenon that has been studied by nutritionists, economists, paediatric endocrinologists; archaeologists, child psychologists and other experts. Yet, a unifying theory of understanding growth regulation is still lacking. Method Critical review of the literature. Results We summarise evidence linking social competition and its effect on hierarchies in social structures, with the neuronal networks of the ventromedial hypothalamus and body size. The endocrine signalling system regulating growth hormone, Insulin-like-Growth-Factor1 and skeletal growth, is well conserved in the evolution of vertebrata for some 400 million years. The link between size and status permits adaptive plasticity, competitive growth and strategic growth adjustments also in humans. Humans perceive size as a signal of dominance with tallness being favoured and particularly prevalent in the upper social classes. Conclusion Westernised societies are competitive. People are tall, and "open to change." Social values include striving for status and prestige implying socio-economic domination. We consider the transition of political and social values following revolutions and civil wars, as key elements that interact with the evolutionarily conserved neuroendocrine competence for adaptive developmental plasticity, overstimulate the hypothalamic growth regulation and finally lead to the recent historic increases in average height.
Background: We investigated average body height in the central provinces of the Russian empire in the middle of XIX century in view of the concept of "community effects on height". We analyzed body height correlations between neighboring districts at this time. We added information about secular changes in body height during the 19th century of this territory. Material and methods: The study used height data of conscripts, which were born in the years 1853-1863, and age 21 at the time of measurement. The territory of seven provinces was considered as a network with 105 nodes, each node representing one district with information on average male body height. In order to define neighboring districts three different approaches were used: based on the "common borders" method, based on Euclidean distances (from 60 to 120 km), based on real road connections. Results: Small but significant correlation coefficients were observed between 1st order districts in the network based on Euclidean distance of 100 km (r = 0.256, p-value = 0.006) and based on "the common borders" approach (r = 0.25, p-value = 0.02). Wherein no significant correlations were observed in the network based on road connections and between second order neighbors regardless of the method. Conclusion: Height correlation coefficients between 1st order neighboring districts observed in the Russian districts were very similar to values observed in the Polish study (r = 0.24). The considered Russian territory and the territory of Poland have a lot in common. They consist of both plains without mountains. In contradistinction to Poland the transport infrastructure in Russia was weakly developed in the middle of XIX century. In addition, the mobility of people was limited by serfdom. In this context the absent of significant correlation of second order neighbors can be explained by low population density and lack of migration and communication between the districts.
The impact of social identity and social dominance on the regulation of human growth: A viewpoint
(2019)
Background: Clinicians often refer anthropometric measures of a child to so-called “growth standards” and “growth references. Over 140 countries have meanwhile adopted WHO growth standards.
Objectives: The present study was conducted to thoroughly examine the idea of growth standards as a common yardstick for all populations. Weight depends on height. We became interested in whether also weight-for-height depends on height. First, we studied the age-group effect on weight-for-height. Thereafter, we tested the applicability of weight-for-height references in short and in historic populations.
Sample and Methods: We analyzed body height and body weight and weight-for-height of 3795 healthy boys and 3726 healthy girls aged 2 to 5 years measured in East-Germany between 1986 and 1990.
We chose contemporary height and weight charts from Germany, the UK, and the WHO growth chart and compared these with three geographically commensurable growth charts from the end of the 19th century.
Results: We analyzed body height and body weight and weight-for-height of 3795 healthy boys and 3726 healthy girls aged 2 to 5 years measured in East-Germany between 1986 and 1990.
We chose contemporary height and weight charts from Germany, the UK, and the WHO growth chart and compared these with three geographically commensurable growth charts of the end of the 19th century.
Conclusion: Weight-for-height depends on age and sex and apart from the nutritional state, reflects body proportion and body built particularly during infancy and early childhood. Populations with a relatively short average height are prone to high values of weight-for-height for arithmetic reasons independent of the nutritional state.
BACKGROUND: Under normal nutritional and health conditions, body height, weight and head circumference are significantly related. We hypothesize that the apparent general association between weight, height, and head circumference of the growing child might be misleading. METHODS: We reanalyzed data of 7,444 boys and 7,375 girls measured in East-Germany between 1986 and 1990, aged from 0 to 7 y with measurements of body length/height, leg length, sitting height, biacromial shoulder breadth, thoracic breadth, thoracic depth, thoracic circumference, body weight, head volume, percentage of body fat, and hip skinfold vertical, using principal component analysis. RESULTS: Strong associations exist between skeletal growth, fat accumulation, and head volume increments. Yet in spite of this general proportionality, skeletal growth, fat acquisition, and head growth exhibit different patterns. Three components explain between almost 60% and more than 75% of cumulative variance between birth and age 7 y. Parameters of skeletal growth predominantly load on the first component and clearly separate from indicators of fat deposition. After age of 2 y, head volume loads on a separate third component in both sexes indicating independence of head growth. CONCLUSION: Under appropriate nutritional and health circumstances, nutritional status, body size, and head circumference are not related.