Adult height, nutrition, and population health

Taller adult height is associated with better performance of cognitive trajectories in Chinese over 45 years old: Evidence from the China Health and Retirement Longitudinal Study

AIM

The association between adult height and follow-up cognition requires an update in China. We aimed to examine the association between baseline height and follow-up cognitive trajectories in Chinese subjects from the China Health and Retirement Longitudinal Study (CHARLS).

METHODS

A total of 6508 adults aged 45 years or older from the CHARLS were included for analysis. Latent class growth modeling was used to determine cognitive trajectories of 2011, 2013 and 2015. Multivariable linear regression and logistic regression models were used to examine the association between baseline adult height and cognitive performance and trajectories, respectively.

RESULTS

At baseline, an increment of 1 SD (8.3 cm) of height was associated with a higher global cognitive score (β = 0.492, 95% CI, 0.348-0.636), verbal episodic memory (β = 0.155, 95% CI, 0.086-0.224) and mental status (β = 0.337, 95% CI, 0.225-0.449). These associations were still observed even when stratified by sex. Prospectively, for females, the third quartile of height level (i.e., 155 to 158 cm) was associated with a better global cognitive function trajectory (OR = 1.627, P = 0.001, P for trend = 0.009) and mental status trajectory (OR = 1.456, P = 0.012, P for trend = 0.047); and the tallest height level (i.e., 159 cm or taller) was related to a better verbal episodic memory trajectory (OR = 1.574, P = 0.017). For males, no associations were observed.

CONCLUSION

Increased stature might be associated with better cognitive trajectories for subjects in China. Geriatr Gerontol Int 2021; 21: 732-740.

Association of life course socioeconomic status and adult height with cognitive functioning of older adults in India and China

BACKGROUND

Cognitive functioning is an important measure of intrinsic capacity. In this study, we examine the association of life course socioeconomic status (SES) and height with cognitive functioning among older adults (50+) in India and China. The age pattern of cognitive functioning with measures of life course socioeconomic status has also been examined.

METHODS

Cross-sectional comparative analysis was conducted using the WHO's Study on global AGEing and adult health (SAGE) data for India and China. Multilevel mixed-effect linear regression analysis was used to examine the association of life course socioeconomic status and adult height with cognitive functioning.

RESULTS

In both India and China, parental education as a measure of childhood socioeconomic status was positively associated with cognitive functioning. The association between adult socioeconomic status and cognitive functioning was positive and significant. Height was significantly and positively associated with improved cognitive functioning of older adults in India and China. Furthermore, the age-related decline in cognitive functioning score was higher among older adults whose parents had no schooling, particularly in China. The cognitive functioning score with age was much lower among less-educated older adults than those with higher levels of education in China. Wealthier older adults in India had higher cognitive functioning in middle ages, however, wealth differences narrowed with age.

CONCLUSIONS

The results of this study suggest a significant association of lifetime socioeconomic status and cumulative net nutrition on later-life cognitive functioning in middle-income settings.

Longitudinal Associations between Intake of Fruit and Vegetables and Height Attainment from Preschool to School Entry

To examine associations between fruit and vegetable intake in young childhood and height attainment during preschool and at school entry. Data for this study was based on "The Healthy Start" primary intervention study, which included 635 obesity-prone children, (58% boys), from the greater Copenhagen area, with a mean (SD) age of 4.0 (1.1) years (age range 2-6 years) at baseline. In the current study, 553 children (57% boys) were included with information on dietary intake at baseline and height measured at baseline (preschool age), and 511 children (56.8% boys) with the height measured at school entry (~6 years old). Height was measured by trained health professionals during the intervention and by school nurses at school entry. Information on intakes of fruit and vegetables, separately and combined, was gathered with four-day dietary records reported by parents. Participants were grouped into tertiles for their intakes at baseline. Compared to boys with low consumption, those with a moderate and high intakes of fruit and vegetables (F&V) had a greater attained height at preschool of 1.3 cm (95% confidence interval (CI): 0.3; 2.3) and at school entry of 2.4 cm (95% CI: 0.8; 3.9) and 1.8 cm (95% CI: 0.2; 3.4), respectively, also after adjustment for differences in age, body mass index (BMI), and total energy intake. Additional adjustment for mid-parental height and parents' education did not alter the significant associations between moderate consumption of F&V and attained height at preschool and school entry. There was no association among girls. Our results showed that a moderate consumption of F&V was directly associated with higher attainment in height at preschool and school entry in boys. From a public health perspective, it should be prioritized to continue developing intervention programs to improve fruit and vegetable intake.

Predicting height from ulna length for the determination of weight status in New Zealand adolescents: A cross-sectional study

BACKGROUND

The measurement of height is crucial for weight status assessment. When standing height is difficult to measure, ulna length may offer a convenient and accurate surrogate of height measure. Adolescence is a period of accelerated linear growth; hence, the validation of age-specific equations that predict height from ulna length in adolescents is warranted. The present study aimed to develop and validate age- and sex-specific equations for predicting height from ulna length in New Zealand adolescents.

METHODS

Height, weight and ulna length were measured in 364 adolescents (n = 110 males, n = 254 females) aged 15.0-18.8 years, who were enrolled in the SuNDiAL (Survey of Nutrition Dietary Assessment and Lifestyle) project, a cross-sectional survey performed in 2019 and 2020. Regression models were used to determine equations to predict height from ulna length. Agreement between measured and predicted height, body mass index (BMI) and BMI z-score was assessed with intra-class correlation coefficients (ICC) and Bland-Altman plots. Sensitivity and specificity were calculated for classifying obesity.

RESULTS

Strong agreement was found between predicted and measured height (ICC = 0.78; mean difference = 0; 95% confidence interval = -0.5 to 0.5 cm) and BMI (ICC = 0.95; mean difference = 0; 95% confidence interval = -0.1 to 0.1 kg m^-2 ). Predicted height was 88.1% accurate when classifiying weight status, showing high sensitivity (93.8%) and specificity (99.4%) for classifying obesity.

CONCLUSIONS

Ulna length measurement can accurately estimate height and subsequently weight status in New Zealand adolescents aged 15-18 years.

Multilevel analysis of geographic variation among correlates of child undernutrition in India

Prior research has identified a number of risk factors ranging from inadequate household sanitation to maternal characteristics as important determinants of child malnutrition and health in India. What is less known is the extent to which these individual‐level risk factors are geographically distributed. Assessing the geographic distribution, especially at multiple levels, matters as it can inform where, and at what level, interventions should be targeted. The three levels of significance in the Indian context are villages, districts, and states. Thus, the purpose of this paper was to (a) examine what proportion of the variation in 21 risk factors is attributable to villages, districts, and states in India and (b) elucidate the specific states where these risk factors are clustered within India. Using the fourth National Family Health Survey dataset, from 2015 to 2016, we found that the proportion of variation attributable to villages ranged from 14% to 63%, 10% to 29% for districts and 17% to 62% for states. Furthermore, we found that Bihar, Jharkhand, Madhya Pradesh, and Uttar Pradesh were in the highest risk quintile for more than 10 of the risk factors included in our study. This is an indication of geographic clustering of risk factors. The risk factors that are clustered in states such as Bihar, Jharkhand, Madhya Pradesh and Uttar Pradesh underscore the need for policies and interventions that address a broader set of child malnutrition determinants beyond those that are nutrition specific.

Prediction of stature from long bones versus hand and foot measurements: A comparative study of the Kolhapur population

Background Estimation of stature is usually done by measurement of the long bones. Although hand and foot dimensions are useful in predicting stature, they are population-specific. Methods We compared the accuracy of predicting stature by hand and foot dimensions, with long bone (tibia and ulna) lengths, and developed a stature predictive regression formula from the parameters used for the sample population in Kolhapur. We recorded hand and foot measurements and long bone measurements of 1000 consenting participants 18-50 years of age using a stadiometer for height and an anthropometric rod compass for other measurements. Correlation between the variables and stature was determined using Pearson's correlation analysis (p<0.05). A multiple linear regression formula was derived for the prediction of stature. Results A positive correlation was observed between mean stature and foot length (r=0.67, p<0.05), tibia (r=0.66, p<0.05), ulna (r= 0.75, p<0.05) and hand length (r=0.69 left, r=0.72 right, p<0.05). There was no correlation between foot breadth and stature. Multiple linear regression analysis of hand and foot dimensions returned R2=62.96 and standard error of estimate 4.689 with comparable computed and experimental measurements. Conclusion The dimensions of the hand and foot can be used to predict stature. The formula derived from the multiple regression analysis incorporating hand and foot dimensions is a good fit to estimate stature in the study population.

Height and quality of life among older adults (50+) in India: a cross-sectional study

Adult height is a summary measure of health and net nutrition in early childhood. This study examines the association between height and quality-of-life outcomes in older adults (50+) in India. Cross-sectional data from Wave 1 of the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) conducted in 2007 were analysed. The association between height and quality of life was assessed using bivariate and multivariate logistic and linear regression models. The mean WHO quality-of-life score (WHO-QoL) increased from 45.2 among the older adults in the lowest height quintile to 53.2 for those in the highest height quintile. However, the prevalence of self-rated poor quality of life declined from 16.4% in the lowest height quintile to 6.1% in the highest height quintile. In the fully adjusted regression model, height was found to be positively associated with quality-of-life outcomes among both men and women, independent of socioeconomic and physical health confounders. The association was particularly strong for women. Women in the highest height quintile had a 2.65 point higher WHO-QoL score than those in the lowest height quintile. Similarly, the likelihood of reporting a poor quality of life was lower among women in the highest height quintile. Furthermore, measures of economic status, handgrip strength, cognitive ability and poor self-rated health were significantly associated with WHO-QoL and self-rated poor quality of life. Overall, this study revealed a significant association between height and quality of life among older adults in India, suggesting a significant role of childhood circumstances in quality of life in later life.

Lower limb kinematic, kinetic, and EMG data from young healthy humans during walking at controlled speeds

Understanding the lower limb kinematic, kinetic, and electromyography (EMG) data interrelation in controlled speeds is challenging for fully assessing human locomotion conditions. This paper provides a complete dataset with the above-mentioned raw and processed data simultaneously recorded for sixteen healthy participants walking on a 10 meter-flat surface at seven controlled speeds (1.0, 1.5, 2.0, 2.5, 3.0, 3.5, and 4.0 km/h). The raw data include 3D joint trajectories of 24 retro-reflective markers, ground reaction forces (GRF), force plate moments, center of pressures, and EMG signals from Tibialis Anterior, Gastrocnemius Lateralis, Biceps Femoris, and Vastus Lateralis. The processed data present gait cycle-normalized data including filtered EMG signals and their envelope, 3D GRF, joint angles, and torques. This study details the experimental setup and presents a brief validation of the data quality. The presented dataset may contribute to (i) validate and enhance human biomechanical gait models, and (ii) serve as a reference trajectory for personalized control of robotic assistive devices, aiming an adequate assistance level adjusted to the gait speed and user's anthropometry.

Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda

13 years after the first Lancet Series on maternal and child undernutrition, we reviewed the progress achieved on the basis of global estimates and new analyses of 50 low-income and middle-income countries with national surveys from around 2000 and 2015. The prevalence of childhood stunting has fallen, and linear growth faltering in early life has become less pronounced over time, markedly in middle-income countries but less so in low-income countries. Stunting and wasting remain public health problems in low-income countries, where 4·7% of children are simultaneously affected by both, a condition associated with a 4·8-times increase in mortality. New evidence shows that stunting and wasting might already be present at birth, and that the incidence of both conditions peaks in the first 6 months of life. Global low birthweight prevalence declined slowly at about 1·0% a year. Knowledge has accumulated on the short-term and long-term consequences of child undernutrition and on its adverse effect on adult human capital. Existing data on vitamin A deficiency among children suggest persisting high prevalence in Africa and south Asia. Zinc deficiency affects close to half of all children in the few countries with data. New evidence on the causes of poor growth points towards subclinical inflammation and environmental enteric dysfunction. Among women of reproductive age, the prevalence of low body-mass index has been reduced by half in middle-income countries, but trends in short stature prevalence are less evident. Both conditions are associated with poor outcomes for mothers and their children, whereas data on gestational weight gain are scarce. Data on the micronutrient status of women are conspicuously scarce, which constitutes an unacceptable data gap. Prevalence of anaemia in women remains high and unabated in many countries. Social inequalities are evident for many forms of undernutrition in women and children, suggesting a key role for poverty and low education, and reinforcing the need for multisectoral actions to accelerate progress. Despite little progress in some areas, maternal and child undernutrition remains a major global health concern, particularly as improvements since 2000 might be offset by the COVID-19 pandemic.

Secular trend and social variation in height of Polish schoolchildren between 1966 and 2012

AIM

To assess secular trend and changes in social inequalities of children's height across nearly 50 years, when vast socio-political changes took place in Poland.

METHODS

Data on schoolchildren aged 7-18 years were collected in 1966, 1978, 1988 and 2012 in Poland. Height was standardised for age using the LMS method. Socio-economic status (SES) was based on 4 factors: urbanisation level, mother's and father's education, and family size (number of children). Statistics included 2-way ANOVA with post hoc Tukey's test and effect size calculations.

RESULTS

Positive secular trend in height was observed across all years. All analysed SES factors had significant effect on height which differed depending on SES category and year of Survey. Differences in height between extreme categories of SES factors decreased gradually, starting from 1978. However, only general SES in girls and urbanisation level in both sexes became insignificant in 2012.

CONCLUSION

Improvement of living conditions across nearly 50 years was reflected in the secular trend in children's height. Despite this improvement, however, the biological effects of social inequalities, visible in differences in height, to some extent, are still present in Poland.

Household and schooling rather than diet offset the adverse associations of height with school competence and emotional disturbance among Taiwanese girls

OBJECTIVE

Short stature may reflect health in early life and be an enduring disability. How birth weight, gender, household, elementary schooling and diet play a role in associations between stature and overall school competence (OSC) have been assessed.

DESIGN

The 2001-2002 Nutrition and Health Survey in Taiwan (NAHSIT) for elementary schoolchildren (n 2274, 52·1 % boys) was linked to birth records. It provided sociodemographic, dietary quality, body compositional and school performance (as Scale for Assessing Emotional Disturbance, SAED; OSC as an SAED subscale) data. Lower birth weight was ≤15th percentile: 2850 g for boys and 2700 g for girls, and stature as z-scores for Taiwanese. Multivariable linear regression was used for relationships between OSC and stature. Trends in OSC by stature and school grade were assessed.

SETTING

The 2001-2002 NAHSIT for elementary schoolchildren.

PARTICIPANTS

Totally, 2274 schoolchildren aged 6-13 years.

RESULTS

Compared to normal height (-2< height for age z-score (HAZ) <2), shorter girls (HAZ ≤ -2) had a lower OSC (8·87 v. 10·5, P < 0·05) and taller girls (HAZ ≥ 2) had a better OSC (12·3 v. 10·5, P < 0·001). Maternal education and household income each contributed more than 5 % of OSC variance. OSC and HAZ among girls were positively associated and emotional disturbance negatively associated. Shortness-associated lower OSC underwent remediation with advancing school grade. Stature and OSC were not evidently related in boys.

CONCLUSIONS

Shorter stature can compromise OSC among school girls. The major determinants in shorter girls are less household income and limited parental education.

Risk factors associated with symptoms of post-extubation upper airway obstruction in the emergency setting

Objective

Post-extubation stridor and hoarseness are important clinical manifestations that indicate laryngeal edema due to intubation. In previous studies the incidence of post-extubation stridor and hoarseness ranged from 1.5% to 26.3% in postoperative patients and patients in the intensive care unit. Female sex and prolonged intubation are reportedly risk factors for post-extubation stridor. However, the risk factors for post-extubation stridor and the appropriate endotracheal tube size in emergency settings remain unknown. This study was performed to identify the risk factors for post-extubation laryngeal edema after emergency intubation.

Methods

A prospective observational study was conducted in a tertiary emergency medical center/trauma center. The primary outcome was post-extubation stridor and hoarseness.

Results

During the study period, 482 emergency intubations and 227 extubations were performed in adult patients. In total, 29% of the patients presented symptoms of stridor and/or hoarseness. Female sex (odds ratio, 2.65; 95% confidence interval, 1.21–5.81) and the duration of intubation (odds ratio, 1.18; 95% confidence interval, 1.05–1.32) were associated with stridor and/or hoarseness.

Conclusions

Patients who undergo emergency intubation have a higher risk of post-extubation upper airway obstruction symptoms than postoperative patients and patients in the intensive care unit, and female sex is associated with these symptoms.

Association between height and hypertension among US adults: analyses of National Health and Nutrition Examination Survey 2007-18

Background

Previous studies that investigated association of height with prevalence and control of hypertension found mixed results. This cross-sectional study explored these associations among US adults (≥20 years).

Methods

The National Health and Nutrition Examination Survey (NHANES) 2007–18 data was analyzed. Height was measured in meters and was converted into centimeters (cm) and was further divided into quartiles: Q1 (135.3–159.2 cm), Q2 (159.3–166.2 cm), Q3 (166.3–173.6 cm), Q4 (173.7–204.5 cm). Hypertension definition of the ‘2017 American College of Cardiology/American Heart Association Guideline’ was used. Logistic regression analyses were conducted to find out the association between the dependent variable and the covariates. Linear regression analyses were conducted to find out the association of height with systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and the covariates among the individuals who were not taking any antihypertensive drugs. Crude odds ratio, adjusted odds ratio (AOR), and adjusted beta-coefficient (for linear regression) with 95% confidence interval (CI) were reported. The following covariates were included: age, gender, race/ethnicity, family income, education level, cholesterol level, high-density lipoprotein level, chronic kidney disease status, diabetes status, smoker, aerobic leisure-time physical activity, and survey period. Sample weight of NHANES was adjusted.

Results

Among the 21,935 participants (47.1% males), the prevalence of hypertension was 46.1%. Among 6154 participants taking medication (43.0% males), 57.2% had uncontrolled hypertension. In the final logistic regression analyses, participants in Q2 height quartile had 20% lower odds of being hypertensive compared to those in Q4 height quartile (AOR: 0.8; 95% CI: 0.7,1.0). Other height categories did not reveal any significant association. Compared to Q4 height category, Q1 (AOR: 1.7; 95% CI: 1.2,2.3), Q2 (AOR: 1.4; 95% CI: 1.1,1.8), and Q3 (AOR: 1.3; 95% CI: 1.1,1.6) height categories had higher odds of uncontrolled hypertension. PP was inversely associated and DBP was positively associated with height.

Conclusions

Although height was not associated with prevalence of hypertension, it had inverse association with uncontrolled hypertension. It was also significantly associated with DBP and PP among the individuals with untreated hypertension.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40885-021-00164-4.

Maternal height-standardized prevalence of stunting in 67 low- and- middle-income countries

Background

Prevalence of stunting is frequently used as a marker of population-level child undernutrition. Parental height varies widely in low- and middle-income countries (LMIC) and is also a major determinant of stunting. While stunting is a useful measure of child health, with multiple causal components, removing the component attributable to parental height may in some cases be helpful to identify shortcoming in current environments.

Methods

We estimated maternal height-standardized prevalence of stunting (SPS) in 67 LMICs and parental height-SPS in 20 LMICs and compared with crude prevalence of stunting (CPS) using data on 575,767 children under-five from 67 Demographic and Health Surveys (DHS). We supplemented the DHS with population-level measures of other child health outcomes from the World Health Organization’s (WHO) Global Health Observatory and the United Nations’ Inter-Agency Group for Child Mortality Estimation. Prevalence of stunting was defined as percentage of children with height-for-age falling below −2 z-scores from the median of the 2006 WHO growth standard.

Results

The average CPS across countries was 27.8% (95% confidence interval [CI], 27.5–28.1%) and the average SPS was 23.3% (95% CI, 23.0–23.6%). The rank of countries according to SPS differed substantially from the rank according to CPS. Guatemala, Bangladesh, and Nepal had the biggest improvement in ranking according to SPS compared to CPS, while Gambia, Mali, and Senegal had the biggest decline in ranking. Guatemala had the largest difference between CPS and SPS with a CPS of 45.2 (95% CI, 43.7–46.9%) and SPS of 14.1 (95% CI, 12.6–15.8%). Senegal had the largest increase in the prevalence after standardizing maternal height, with a CPS of 28.0% (95% CI, 25.8–30.2%) and SPS of 31.6% (95% CI, 29.5–33.8%). SPS correlated better than CPS with other population-level measures of child health.

Conclusion

Our study suggests that CPS is sensitive to adjustment for maternal height. Maternal height, while a strong predictor of child stunting, is not amenable to policy interventions. We showed the plausibility of SPS in capturing current exposures to undernutrition and infections in children.

Now you see them, and now you don't: An evolutionarily informed model of environmental influences on human sex differences

The contributions of evolutionary processes to human sex differences are vigorously debated. One counterargument is that the magnitude of many sex differences fluctuates from one context to the next, implying an environment origin. Sexual selection provides a framework for integrating evolutionary processes and environmental influences on the origin and magnitude of sex differences. The dynamics of sexual selection involve competition for mates and discriminative mate choices. The associated traits are typically exaggerated and condition-dependent, that is, their development and expression are very sensitive to social and ecological conditions. The magnitude of sex differences in sexually selected traits should then be largest under optimal social and ecological conditions and shrink as conditions deteriorate. The basics of this framework are described, and its utility is illustrated with discussion of fluctuations in the magnitude of human physical, behavioral, and cognitive sex differences.

Assessing the effects of autarchic policies on the biological well-being: Analysis of deviations in cohort male height in the Valencian Community (Spain) during Francoist regime

This article aims to assess the impact of autarchic policies on the biological dimensions of human well-being during Francoist regime in Spain. This is done by examining the nutritional status of the population through the study of male adult heights. Our case study is the Valencian Community with the focus on the period 1940-59 which witnessed the implementation of such policies. The heights of 21-year old draftees born between 1900 and 1954 from nine municipalities (N = 87,510) were analyzed in the light of inter-cohort deviations from a secular trend established for cohorts that were not exposed to autarchy-related hardships. Height was regressed on infant mortality as a way to control for infection and therefore approach the net effect of nutrition on height outcomes. Contrarily to what was displayed by cohort height trends in themselves, the results reveal a significant worsening of the nutritional status of the male population at the time. Deviations from the expected height trend across municipalities ranged between -0.5 and -3.4 mm per year. The effects of malnutrition are found to be larger among cohorts born in the period 1920-34 in coherence with a longer exposure to autarchy hardships during adolescence. Pre-autarchy nutrition levels observed among the cohorts of 1900-14 were not regained until the cohorts 1945-49. The results also show that malnutrition had an unequal impact with the large industrial towns of our sample experiencing the poorest height outcomes. Overall, these results invite to revise conclusions obtained from the sole evidence of height trends and they question the efficiency of intervention policies implemented in Spain during the 1940s.

Ten2Twenty-Ghana: Study Design and Methods for an Innovative Randomized Controlled Trial with Multiple-Micronutrient-Fortified Biscuits among Adolescent Girls in Northeastern Ghana

Investing in adolescent girls' nutrition is vital for health and for breaking the intergenerational cycle of malnutrition and deprivation, but limited knowledge on the type, timing, and efficacy of interventions delays progress. We describe the design of a 26-wk randomized placebo-controlled trial with multiple-micronutrient-fortified biscuits (MMBs) among adolescent girls in northeastern Ghana. Apparently healthy, premenarche (n = 312) and postmenarche (n = 309) girls (10-17 y) were randomly assigned to receive the following for 5 d/wk: 1) MMBs (fortified with 11 vitamins and 7 minerals) or 2) unfortified biscuits. Data included plasma micronutrient status, anthropometry, body composition, cognitive function, psychosocial health, fertility, dietary intake, and sociodemographic and socioeconomic covariates, complemented with in-depth interviews (n = 30) and 4 focus group discussions. We hypothesized an increase in plasma ferritin and retinol-binding protein with a resultant increase in hemoglobin, cognition, vertical height, and psychosocial health. Our study seeks to investigate the efficacy and optimal timing of a multiple-micronutrient food intervention program for adolescent girls. The RCT was registered prospectively with the Netherlands Clinical Trials Register (NL7487).

Influence of height on blood pressure and hypertension among Bangladeshi adults

Background

Recent studies have reported that height is inversely associated with blood pressure and hypertension. However, there is lack of comprehensive findings from Bangladesh in this regard.

Objective

The purpose of this study was to explore the association between height and blood pressure in a Bangladeshi population.

Setting

Rural and urban sites from seven divisions of Bangladesh.

Participants

Participants were 7932 males and females (aged ≥35 years) evaluated in the 2011 Bangladesh Demographic Health Survey. Participants (n = 7647) who had complete height, weight, systolic and diastolic blood pressure (SBP and DBP) measurements and non-missing medication history, were included in the analysis.

Methods

Hypertension was defined as an SBP over 140 mmHg or/and a DBP over 90 mmHg, or current use of antihypertensive medication. Difference between SBP and DBP was calculated to get pulse pressure (PP). Multivariate linear and logistic regression models were used.

Results

PP decreased linearly with increasing height among males (−0.11, P < 0.05) and females (−0.19, P < 0.05) after adjusting for age, BMI, living region, type of occupation, wealth index, and highest level of education. SBP decreased linearly with increasing height among only females (−0.14, P < 0.05), after adjusting for age, BMI, living region, type of occupation, wealth index, and highest level of education. No association was found between quartiles of height and prevalence of hypertension.

Conclusions

Height was found to be inversely associated with pulse pressure in both sexes. Studies with longitudinal design are needed to investigate the association between shortness with blood pressure and hypertension.

Stature estimation from handprint measurements: an application to the medicolegal investigation

Background

The estimation of the stature of human beings is a major part of medicolegal investigation when only body parts are found. The study aimed to estimate the stature from different handprint measurements in a Bangladeshi population using statistical considerations. A sample of 200 young Bangladeshi adults (100 men and 100 women) with no physical disabilities participated in this study. Stature and seven anthropometric measurements were measured using standard anthropometric measurements. The bilateral asymmetry was tested using the independent t test. The Pearson’s correlation coefficient (R) between the stature and different handprint measurements was calculated. Consequently, the simple and multiple linear regression models were developed to estimate the stature from the handprint measurements.

Results

The bilateral asymmetry was statistically not significant (p > 0.05) in right and left handprints. Sex difference significantly (p < 0.05) influences the relationship between stature and handprint measurements. A positive and strong coefficient of correlation (R) value presents between stature and the handprint measurements. The right 2^nd digit length in men (R = + 0.709, R² = 0.502, SEE = ± 44.141 mm) and the right handprint length in women (R = + 0.552, R² = 0.305, SEE = ± 49.074 mm) were the most reliable estimator of stature. However, when data were combined for both sexes, the right handprint length was identified as the most reliable estimator of stature with higher values of R (+ 0.777) and R² (0.603), and a lower value of SEE (± 55.520). Multiple regression equation showed greater reliability than linear regression equations in stature estimation from handprint measurements in Bangladeshi population.

Conclusions

It was concluded that the estimation of stature from handprint measurements is possible and reliable. The findings of this study are very useful from the forensic and medicolegal point of view and can use to estimate the stature in Bangladeshi population.

The pace of secular changes of body measurements of children and adolescents from Kolkata (India) in the context of socioeconomic inequalities between the sexes

OBJECTIVES

To examine the pace of secular changes of selected body measurements and proportions of children and adolescents from Kolkata (India), between 1952-1966 and 1999-2011 in the context of differences between the sexes.

METHODS

The study group consisted of 7753 children, adolescents and young adults (7-21 years of age) included in two series of studies (1952-1966 and 2005-2011). The measurements included: body height, sitting height, biacromial and biiliocristal diameters, as well as body mass. Additionally, subishial leg length was derived. The pace of the observed intergenerational trends was estimated on the basis of the differences of the mean values of the analyzed characteristics between both cohorts and expressed as the change of a given parameter for a decade. Information regarding the educational and professional status of the parents of participants was obtained using a questionnaire.

RESULTS

In the majority of the analyzed characteristics, the pace of intergenerational changes was significantly higher among males, in comparison to females. It was visible especially during adolescence-between 11 and 19 years of age. The positive trends, especially, for characteristics such as body height or limb lengths occurred significantly quicker in males, in comparison to females.

CONCLUSIONS

There were significant differences between the sexes in the pace of secular changes regarding the growth of the examined population. Considering the relatively homogenous economic situation of the families of the participants, it was more likely that those discrepancies effected from the social and domestic division of sexes, and the resulting differences in growth and development conditions.

IGF-I deficiency and enhanced insulin sensitivity due to a mutated growth hormone receptor gene in humans

Human size is achieved by the coordinated expression of many genes. From conception to adulthood, a given genomic endowment is modified by highly variable environmental circumstances. During each stage of a person's life, distinct nutritional and hormonal influences continuously shape growing physical features until mature characteristics are attained. Underlying processes depend on precise provision of substrates and energy extracted by insulin action from nutrients, which allows cell proliferation, differentiation, and survival, under the concerted actions of growth hormone and insulin-like growth factor-I (IGF-I). It should be noted that growth and metabolic signaling pathways are interdependent and superimposed at multiple levels. Attainment of a fully developed human phenotype should be considered as a harmonious increment in body size rather than a simple increase in height. From this perspective we herein analyze adult features of individuals with an inactive growth hormone receptor, who consequently have severely diminished concentrations of serum insulin and endocrine IGF-I.

Coronary heart disease and stroke in the Sami and non-Sami populations in rural Northern and Mid Norway-the SAMINOR Study

BACKGROUND

Previous studies have suggested that Sami have a similar risk of myocardial infarction and a higher risk of stroke compared with non-Sami living in the same geographical area.

DESIGN

Participants in the SAMINOR 1 Survey (2003-2004) aged 30 and 36-79 years were followed to the 31 December 2016 for observation of fatal or non-fatal events of acute myocardial infarction (AMI), coronary heart disease (CHD), ischaemic stroke (IS), stroke and a composite endpoint (fatal or non-fatal AMI or stroke).

AIM

Compare the risk of AMI, CHD, IS, stroke and the composite endpoint in Sami and non-Sami populations, and identify intermediate factors if ethnic differences in risks are observed.

METHODS

Cox regression models.

RESULTS

The sex-adjusted and age-adjusted risks of AMI (HR for Sami versus non-Sami 0.99, 95% CI: 0.83 to 1.17), CHD (HR 1.03, 95% CI: 0.93 to 1.15) and of the composite endpoint (HR 1.09, 95% CI: 0.95 to 1.24) were similar in Sami and non-Sami populations. Sami ethnicity was, however, associated with increased risk of IS (HR 1.36, 95% CI: 1.10 to 1.68) and stroke (HR 1.31, 95% CI: 1.08 to 1.58). Height explained more of the excess risk observed in Sami than conventional risk factors.

CONCLUSIONS

The risk of IS and stroke were higher in Sami and height was identified as an important intermediate factor as it explained a considerable proportion of the ethnic differences in IS and stroke. The risk of AMI, CHD and the composite endpoint was similar in Sami and non-Sami populations.

Short interpregnancy interval and low birth weight births in India: Evidence from National Family Health Survey 2015-16

Evidence on the effect of interpregnancy interval (IPI) on low birth weight (LBW) births is limited in developing countries including India. Our study aims to examine association between IPI and LBW births in India. We used data from the fourth round of the National Family Health Survey (NFHS-4) conducted in 2015–16 with a representative sample of 52,825 most recent births for examining the association between IPI and LBW. IPI is defined as the gap between the first month in which the index pregnancy was reported in the reproductive calendar (referred to as the month of conception) and the month of pregnancy outcome (including live births and terminations) of preceding pregnancy. Reproductive calendar data were used to estimate IPI. Association between IPI and LBW were examined using multivariable binary logistic regressions. Seventeen percent of the births in our sample were LBW, and more than half (57.6%) of these were accompanied with IPI less than 18 months. Prevalence of LBW births was highest among mother's who had IPI less than six months (19.4%). Regression results, adjusted for control variables, indicate that the risk of LBW was significantly higher among births whose mothers had IPI less than six months (odds ratio: 1.19, 95% CI:1.05-1.36) compared with those whose mothers had IPI between 18 and 23 months. This study provides additional evidence on the association between short IPI (<6 months) and LBW births in India. Promoting spacing methods of family planning is an option that India may consider for increasing the IPI and thereby reducing LBW births. Ensuring recommended iron and folic acid tablets/equivalent syrup and TT injections for every pregnant woman may offset the adverse consequences of shorter IPI.

•

12% of the LBW births were accompanied with IPI <6 months, 20% between 6 and 11 months, and 25% between 12 and 17 months.

•

The risk of LBW births is higher among mothers having an IPI of <6 months compared with mothers having an IPI of 18–23 months.

•

Promoting spacing methods of family planning may consider for increasing the IPI and thereby reducing LBW births in India.

•

Promoting recommended TT injections and iron-folic acid supplements may offset the adverse consequences of short IPI.

A typology of dietary and anthropometric measures of nutritional need among children across districts and parliamentary constituencies in India, 2016

BACKGROUND

Anthropometry is the most commonly used approach for assessing nutritional need among children. Anthropometry alone, however, cannot differentiate between the two immediate causes of undernutrition: inadequate diet vs disease. We present a typology of nutritional need by simultaneously considering dietary and anthropometric measures, dietary and anthropometric failures (DAF), and assess its distribution among children in India.

METHODS

We used the 2015-16 National Family Health Survey, a nationally representative sample of children aged 6-23 months (n = 67 247), from India. Dietary failure was operationalized using World Health Organization (WHO) standards for minimum dietary diversity. Anthropometric failure was operationalized using WHO child growth reference standard z-score of <-2 for height-for-age (stunting), weight-for-age (underweight) and weight-for-height (wasting). We also created a combined anthropometric measure for children who had any one of these three anthropometric failures. We cross-tabulated dietary and anthropometric failures to produce four combinations: Dietary Failure Only (DFO), Anthropometric Failure Only (AFO), Both Failures (BF), and Neither Failure (NF). We estimated the prevalence and distribution of the four types, nationally, and across 640 administrative districts and 543 Parliamentary Constituencies (PCs) in India.

RESULTS

Nationally, 80.3% of children had dietary failure and 53.7% had at least one anthropometric failure. The prevalence for the four DAF types was: 44.0% (BF), 36.3% (DFO), 9.8% (AFO), and 9.9% (NF). Dietary and anthropometric measures were discordant for 46.1% of children; these children had nutritional needs identified by only one of the two measures. Nationally, this translates to 12 181 627 children with DFO and 3 281 913 children with AFO; the nutritional needs of these children would not be captured if using only dietary or anthropometric assessment. Substantial variation was observed across districts and PCs for all DAF types. The interquartile ranges for districts were largest for BF (29.8%-53.0%) and lowest for AFO (5.5%-13.4%).

CONCLUSIONS

The current emphasis on anthropometry for measuring nutritional need should be complemented with diet- and food-based measures. By differentiating inadequate food intake from other causes of undernutrition, the DAF typology brings precision in identifying nutritional needs among children. These insights may improve the development and targeting of nutrition interventions.

Can shorter mothers have taller children? Nutritional mobility, health equity and the intergenerational transmission of relative height

This study develops the concept of nutritional mobility, defined here as the probability that a mother ranked low in her cohort's height distribution will have a child who attains a higher rank order. We demonstrate that rank-order regression provides a robust metric of health equity, revealing differences in opportunities for each child to reach their own growth potential. We estimate four indicators of nutritional mobility and test for associations between nutritional mobility and various local economic and environmental factors. Nutritional mobility has improved over time, and the nutrition environment contributes about 2.86 times as much as a mother's height to her child's expected rank in height-for-age. Populations with the least mobility are in Latin America, and the most mobility is in more urbanized areas of Africa and Asia. Rank-order mobility is an important aspect of health equity, offering valuable insight into the role of socioecological factors in nutrition improvement across generations.

The use of Broca index to assess cut- off points for overweight in adults: A short review

The Broca formula was developed in 1871 by Pierre Paul Broca (a French Army Doctor) to help establish ideal body weight or normal body weight. Initially, the Broca Index (BI) was used to work out the normal weight but was later expanded to ideal Body Weight. Ideal Body weight (kg) = [Height (cm)-100]. The common methods used to explore the levels of adiposity include body mass index (BMI), waist circumference, skinfolds, bioelectrical impedance analysis, dual energy x-ray absorptiometry (DEXA), computerized tomography (CT) and magnetic resonance imaging (MRI). Even though there have been several anthropometric measurements discoveries to assess obesity, BMI is still widely used in many clinic centers around the world. It remains simple and relatively inexpensive to measure and easily obtainable in non-laboratory settings. In this review, we will summarize the common methods used to measure body fat and their limitations. Second, we will show the correlation that may exist between Broca Index and BMI cutoffs. Last, we will underline some potential clinical usefulness that may present Broca index in assessing body fat.

Independent associations of women's age at marriage and first pregnancy with their height in rural lowland Nepal

OBJECTIVES

In many South Asian communities, the majority of women are married during adolescence and reproduce before 20 years. Early reproduction may adversely affect maternal nutrition and linear growth, however whether early marriage has similar effects is unknown. Shorter women might also be preferentially chosen for earlier marriage. We hypothesized that early marriage and early pregnancy may each be associated with women's shorter height, independent of any selection effects.

MATERIALS AND METHODS

We analyzed cross-sectional data on 7,146 women aged 20-30 years from rural lowland Nepal. Linear regression models tested associations of early marriage and early reproduction with height, adjusting for women's education and husbands' characteristics (education and wealth) that might index preferential selection of short young women for marriage.

RESULTS

Median ages at marriage and first pregnancy were 15 and 18 years, respectively, with 20% pregnant <16 years. Both early marriage and early pregnancy were independently associated with shorter stature, accounting for a decrement of 1.4 cm, which decreased to 1 cm after adjusting for women's education. Effects of early marriage and reproduction persisted after adjusting for the tendency of poorer and less educated men to marry young and short women, indicating a role for social selection.

DISCUSSION

The decrements in height associated with early marriage and reproduction are indicative of broader adverse effects on maternal metabolism during a "critical period" of growth and maturation in the life-course of women. Although the magnitudes of effect are relatively small, they affect large numbers of women in this population.

A longitudinal study of height gaps among Mexican children: Disparities and social inequity

RATIONALE

Health outcomes such as height are important determinants of social inequities.

OBJECTIVE

We assess height gaps in Mexico among boys and girls from distinct subpopulation groups over time.

METHOD

We use longitudinal data from the first three waves of the Mexican Family Life Survey (MxFLS) to analyze children's height differentials by gender and by indigenous and poverty status over 7-10 years. We control for children's characteristics, household factors, and mother's height and use the Blinder-Oaxaca Decomposition method to explain disparities in children's height across the three waves of the MxFLS.

RESULTS

The main findings suggest that height inequalities among indigenous and extremely poor boys and girls, compared with their non-indigenous and less socioeconomically disadvantaged counterparts, are persistent. The results also reveal that height disparities among girls are consistently greater than those among boys in similar population groups and that height gaps increase over time for girls.

CONCLUSIONS

These findings indicate the relevance of social and economic determinants on children's growth potential and the need to examine the association of social determinants on health outcomes. They also underscore the necessity to design and implement public policies that consider a gender perspective.

Downregulation of the GHRH/GH/IGF1 axis in a mouse model of Börjeson-Forssman-Lehman syndrome

Börjeson-Forssman-Lehmann syndrome (BFLS) is an intellectual disability and endocrine disorder caused by plant homeodomain finger 6 (PHF6) mutations. Individuals with BFLS present with short stature. We report a mouse model of BFLS, in which deletion of Phf6 causes a proportional reduction in body size compared with control mice. Growth hormone (GH) levels were reduced in the absence of PHF6. Phf6 ^{- /Y} animals displayed a reduction in the expression of the genes encoding GH-releasing hormone (GHRH) in the brain, GH in the pituitary gland and insulin-like growth factor 1 (IGF1) in the liver. Phf6 deletion specifically in the nervous system caused a proportional growth defect, indicating a neuroendocrine contribution to the phenotype. Loss of suppressor of cytokine signaling 2 (SOCS2), a negative regulator of growth hormone signaling partially rescued body size, supporting a reversible deficiency in GH signaling. These results demonstrate that PHF6 regulates the GHRH/GH/IGF1 axis.

Frequency of Recent Binge Drinking Is Associated With Sex-Specific Cognitive Deficits: Evidence for Condition-Dependent Trait Expression in Humans

Evolutionary theory suggests that commonly found sex differences are largest in healthy populations and smaller in populations that have been exposed to stressors. We tested this idea in the context of men’s typical advantage (vs. women) in visuospatial abilities (e.g., mental rotation) and women’s typical advantage (vs. men) in social-cognitive (e.g., facial-expression decoding) abilities, as related to frequent binge drinking. Four hundred nineteen undergraduates classified as frequent or infrequent binge drinkers were assessed in these domains. Trial-level multilevel models were used to test a priori Sex × Group (binge drinking) interactions for visuospatial and social-cognitive tasks. Among infrequent binge drinkers, men’s typical advantage in visuospatial abilities and women’s typical advantage in social-cognitive abilities was confirmed. Among frequent binge drinkers, men’s advantage was reduced for one visuospatial task (Δ d = 0.29) and eliminated for another (Δ d = 0.75), and women’s advantage on the social-cognitive task was eliminated (Δ d = 0.12). Males who frequently engaged in extreme binges had exaggerated deficits on one of the visuospatial tasks, as did their female counterparts on the social-cognitive task. The results suggest sex-specific vulnerabilities associated with recent, frequent binge drinking, and support an evolutionary approach to the study of these vulnerabilities.

Analysis of Attained Height and Diabetes Among 554,122 Adults Across 25 Low- and Middle-Income Countries

OBJECTIVE

The prevalence of type 2 diabetes is rising rapidly in low-income and middle-income countries (LMICs), but the factors driving this rapid increase are not well understood. Adult height, in particular shorter height, has been suggested to contribute to the pathophysiology and epidemiology of diabetes and may inform how adverse environmental conditions in early life affect diabetes risk. We therefore systematically analyzed the association of adult height and diabetes across LMICs, where such conditions are prominent.

RESEARCH DESIGN AND METHODS

We pooled individual-level data from nationally representative surveys in LMICs that included anthropometric measurements and diabetes biomarkers. We calculated odds ratios (ORs) for the relationship between attained adult height and diabetes using multilevel mixed-effects logistic regression models. We estimated ORs for the pooled sample, major world regions, and individual countries, in addition to stratifying all analyses by sex. We examined heterogeneity by individual-level characteristics.

RESULTS

Our sample included 554,122 individuals across 25 population-based surveys. Average height was 161.7 cm (95% CI 161.2-162.3), and the crude prevalence of diabetes was 7.5% (95% CI 6.9-8.2). We found no relationship between adult height and diabetes across LMICs globally or in most world regions. When stratifying our sample by country and sex, we found an inverse association between adult height and diabetes in 5% of analyses (2 out of 50). Results were robust to alternative model specifications.

CONCLUSIONS

Adult height is not associated with diabetes across LMICs. Environmental factors in early life reflected in attained adult height likely differ from those predisposing individuals for diabetes.

Timing of Childhood-Onset Systemic Lupus Erythematosus Diagnosis Relative to Menarche and the Impact on Final Adult Height

OBJECTIVE

The aim of this study was to examine the impact of timing of a childhood-onset systemic lupus erythematosus (SLE) diagnosis relative to menarchal status, on final height, accounting for disease-associated factors.

METHODS

We conducted a cohort study of female patients age <18 years at childhood-onset SLE diagnosis, followed at a tertiary care pediatric center from July 1982 to March 2016, and restricted to patients with documented age of menarche and final height. We compared final height between patients diagnosed pre- and postmenarche. We tested the association of the timing of childhood-onset SLE diagnosis with final height, adjusted for ethnicity, in linear regression models. We performed subgroup analyses of patients with growth during follow-up, additionally adjusting for average daily corticosteroid dose and disease activity.

RESULTS

Of 401 female childhood-onset SLE patients in the study, 115 patients (29%) were diagnosed premenarche and 286 (71%) postmenarche. Patients diagnosed premenarche were older at menarche compared with patients diagnosed postmenarche (mean ± SD age 13.5 ± 1.4 versus 12.5 ± 1.3 years; P < 0.001). The mean ± SD final height for girls diagnosed postmenarche (161.4 ± 6.9 cm) was greater than for those diagnosed premenarche (158.8 ± 7.3 cm; P = 0.001). In regression analysis, those diagnosed postmenarche were significantly taller than those diagnosed premenarche, as adjusted for ethnicity and disease severity (mean ± SD β = 2.6 ± 0.7 cm; P = 0.0006).

CONCLUSION

In this large cohort study of girls with childhood-onset SLE, patients diagnosed postmenarche achieved a taller final height than those diagnosed premenarche, even after accounting for ethnicity and disease severity.

Interventions to improve linear growth during complementary feeding period for children aged 6-24 months living in low- and middle-income countries: a systematic review and network meta-analysis

Background: Optimizing linear growth in children during complementary feeding period (CFP) (6-24 months) is critical for their development. Several interventions, such as micronutrient and food supplements, deworming, maternal education, and water, sanitation and hygiene (WASH), could potentially be provided to prevent stunting, but their comparative effectiveness are currently unclear. In this study, we evaluated comparative effectiveness of interventions under these domains on child linear growth outcomes of height-for-age z-score (HAZ) and stunting (HAZ <-2SD) Methods: For this study, we searched for low- and middle-income country (LMIC)-based randomized clinical trials (RCTs) of aforementioned interventions provided to children during CFP. We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We performed random-effects network meta-analysis (NMA) for HAZ and stunting. Results: The evidence base for our NMA was based on 79 RCTs (96 papers) involving 81,786 children. Among the micronutrients, compared to standard-of-care, iron + folic acid (IFA) (mean difference =0.08; 95% credible interval [CrI]: 0.01, 0.15) and multiple micronutrients (MMN) (mean difference =0.06; 95%CrI: 0.01, 0.11) showed improvements for HAZ; MMN also reduced the risks for stunting (RR=0.86; 95%Crl: 0.73, 0.98), whereas IFA did not (RR=0.92; 95%Crl: 0.64, 1.23). For food supplements, flour in the caloric range of 270-340 kcal (RR=0.73; 95%Crl: 0.51, 1.00) and fortified lipid-based nutrient supplements (LNS) containing 220-285 kcal (RR=0.80; 95%Crl: 0.66, 0.97) decreased the risk of stunting compared to standard-of-care, but these interventions and other food supplements did not show improvements for HAZ. Deworming, maternal education, and WASH interventions did not show improvements for HAZ nor stunting. Conclusion: While we found micronutrient and food supplements to be effective for HAZ and/or stunting, the evidence base for other domains in this life stage was limited, highlighting the need for more investigation. Registration: PROSPERO CRD42018110449; registered on 17 October 2018.

Interventions to improve linear growth during complementary feeding period for children aged 6-24 months living in low- and middle-income countries: a systematic review and network meta-analysis

Background: Optimizing linear growth in children during complementary feeding period (CFP) (6-24 months) is critical for their development. Several interventions, such as micronutrient and food supplements, deworming, maternal education, and water, sanitation and hygiene (WASH), could potentially be provided to prevent stunting, but their comparative effectiveness are currently unclear. In this study, we evaluated comparative effectiveness of interventions under these domains on child linear growth outcomes of height-for-age z-score (HAZ) and stunting (HAZ <-2SD)

Methods: For this study, we searched for low- and middle-income country (LMIC)-based randomized clinical trials (RCTs) of aforementioned interventions provided to children during CFP. We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We performed random-effects network meta-analysis (NMA) for HAZ and stunting.

Results: The evidence base for our NMA was based on 79 RCTs (96 papers) involving 81,786 children. Among the micronutrients, compared to standard-of-care, iron + folic acid (IFA) (mean difference =0.08; 95% credible interval [CrI]: 0.01, 0.15) and multiple micronutrients (MMN) (mean difference =0.06; 95%CrI: 0.01, 0.11) showed improvements for HAZ; MMN also reduced the risks for stunting (RR=0.86; 95%Crl: 0.73, 0.98), whereas IFA did not (RR=0.92; 95%Crl: 0.64, 1.23). For food supplements, flour in the caloric range of 270-340 kcal (RR=0.73; 95%Crl: 0.51, 1.00) and fortified lipid-based nutrient supplements (LNS) containing 220-285 kcal (RR=0.80; 95%Crl: 0.66, 0.97) decreased the risk of stunting compared to standard-of-care, but these interventions and other food supplements did not show improvements for HAZ. Deworming, maternal education, and WASH interventions did not show improvements for HAZ nor stunting.

Conclusion: While we found micronutrient and food supplements to be effective for HAZ and/or stunting, the evidence base for other domains in this life stage was limited, highlighting the need for more investigation.

Registration: PROSPERO CRD42018110449; registered on 17 October 2018.

Short adult height increases the risk of end-stage renal disease in type 2 diabetes

OBJECTIVE

Although short adult height has been associated with an increasing variety of diseases and all-cause death, no reliable data exist on the association between adult height and end-stage renal disease (ESRD) in diabetic patients. We investigated the relationship between short adult height, development of ESRD, and mortality in type 2 diabetes mellitus (DM).

METHODS

This nationwide population-based cohort study analyzed clinical data from a total of 2,621,907 subjects aged ≥30 years with type 2 DM between January 1, 2009 and December 31, 2012, using the National Health Insurance Database in Korea.

RESULTS

During a 6.9-year follow-up period, 220,457 subjects (8.4%) died, and 28,704 subjects (1.1%) started dialysis. Short adult height significantly increased the incidence of ESRD and all-cause mortality in the overall cohort analysis. In multivariable Cox models, hazard ratios (HR) for the development of ESRD comparing the highest and lowest quartiles of adult height were 0.86 (95% CI 0.83-0.89). All-cause mortality also decreased with the highest height compared to patients with the lowest height, after fully adjusting for confounding variables (HR 0.79, 95% CI 0.78-0.81). Adult height had an inverse relationship to newly diagnosed ESRD (male: HR 0.86, 95% CI 0.83-0.90, female: HR 0.84, 95% CI 0.79-0.90) and all-cause mortality (male: HR 0.81, 95% CI 0.79-0.82, female: HR 0.80, 95% CI 0.78-0.82).

CONCLUSIONS

Short adult height is strongly associated with the increased risk of ESRD development and all-cause mortality in type 2 DM.

Estimating the proportion of overweight soldiers in the Australian Army by combat uniform waist size

INTRODUCTION

Recent studies have shown an increasing number of overweight and obese members serving in many armies. Overweight and obesity can be estimated using either body mass index or waist circumference measures. The aim of this research was to estimate the proportion of the Australian Army considered to be overweight and obese by waist circumference using the proxy measure of issued combat uniform waist size.

METHOD

The Australian Army has been progressively replacing combat uniforms with a new uniform design and camouflage pattern since 2016. The total number of issued combat uniforms by size was obtained from the points of issue for the three Australian Army combat brigades from the first issue of the new uniform in January 2016 through to November 2019. The waist size of issued combat pants was collated from each of the three points of issue, adjusted for measured waist size accuracy and sex, and analysed to estimate the proportion of overweight and obese soldiers in the Australian Army.

RESULTS

There were a total of 155 735 combat pants issued across the three points of issue. The mean waist size based on combat uniform pant size was found to be 90.4 cm, with an SD of 7.5 cm. Based on these data, approximately 23.3% of the Australian Army population can be estimated to be overweight and an additional 4.5% to be obese.

CONCLUSIONS

The Australian Army, like many western armies, has a significant proportion of overweight personnel. This can negatively affect operational capability, health and future healthcare costs both within the military and to society after military service has concluded. This is the first study to use a uniform waist size as a proxy to estimate overweight and obesity. This technique has application for the military, emergency services or any other organisation in which uniforms are provided.

Economic development in Puerto Rico after US annexation: Anthropometric evidence

This paper considers economic development in Puerto Rico following its annexation by the United States in 1898, a watershed moment in the history of the island and the pinnacle of American imperialism in Latin America. Drawing on data from three surveys, I show that male height in Puerto Rico increased at more than twice the average rate for Latin America and the Caribbean between 1890 and 1940. I also show that Puerto Ricans at mid-century were among the tallest Latin Americans outside of Argentina and Uruguay. The evidence supports the conclusion that conditions improved substantially after US annexation, in contrast to the prevailing view in the literature.

Empirical comparisons of multiple Mendelian randomization approaches in the presence of assortative mating

BACKGROUND

Mendelian randomization (MR) is widely used to unravel causal relationships in epidemiological studies. Whereas multiple MR methods have been developed to control for bias due to horizontal pleiotropy, their performance in the presence of other sources of bias, like non-random mating, has been mostly evaluated using simulated data. Empirical comparisons of MR estimators in such scenarios have yet to be conducted. Pleiotropy and non-random mating have been shown to account equally for the genetic correlation between height and educational attainment. Previous studies probing the causal nature of this association have produced conflicting results.

METHODS

We estimated the causal effect of height on educational attainment in various MR models, including the MR-Egger and the MR-Direction of Causation (MR-DoC) models that correct for, or explicitly model, horizontal pleiotropy.

RESULTS

We reproduced the weak but positive association between height and education in the Netherlands Twin Register sample (P= 3.9 × 10-6). All MR analyses suggested that height has a robust, albeit small, causal effect on education. We showed via simulations that potential assortment for height and education had no effect on the causal parameter in the MR-DoC model. With the pleiotropic effect freely estimated, MR-DoC yielded a null finding.

CONCLUSIONS

Non-random mating may have a bearing on the results of MR studies based on unrelated individuals. Family data enable tests of causal relationships to be conducted more rigorously, and are recommended to triangulate results of MR studies assessing pairs of traits leading to non-random mate selection.

Maternal height associated with cesarean section. A cross-sectional study using the 2014-2015 national maternal-child health survey in Guatemala

BACKGROUND

Socioeconomic status is associated with cesarean section (CS). Maternal height, however, may be another related factor to CS. In Guatemala, a quarter of women between 15 and 49 years of age are shorter than 145 cm. Therefore, this study aims to examine the association of maternal height with cesarean section in Guatemala.

METHODS

We carried out a secondary analysis study using data from the 2014-15 Guatemalan national maternal and child health survey-9542 mothers aged 15-49 and 12,426 live births were analyzed. We obtained the prevalence ratio of the association between maternal height and CS based on three Poisson regression models. One model included all live births, another the first live birth, and a third model the last live birth. For each model, we accounted for covariates and sampling design.

RESULTS

The national prevalence of CS was 26.3% (95%CI: 25.0, 27.7). The adjusted prevalence ratio of CS, including all live births, was 1.63 (95%CI: 1.37, 1.94) more likely in mothers shorter than 145 cm compared with those equal or greater than 170 cm. This figure was 1.45 (95%CI: 1.19, 1.76) in the model with the first live birth. In the model with the last birth, maternal height was not associated with CS after accounting for previous CS as one of the covariates.

CONCLUSIONS

Prevalence of CS in this setting was high and above international recommendations. Further, very short mothers were more likely to experience CS compared to taller mothers after accounting for covariates, except when a previous CS was present. Maternal height should be included in clinical assessments during prenatal care.

Women's socioeconomic position in ontogeny is associated with improved immune function and lower stress, but not with height

Immune function, height and resource accumulation comprise important life history traits in humans. Resource availability models arising from life history theory suggest that socioeconomic conditions influence immune function, growth and health status. In this study, we tested whether there are associations between family income during ontogeny, adult height, cortisol level and immune response in women. A hepatitis B vaccine was administered to 66 young Latvian women from different socioeconomic backgrounds, and blood samples were then collected to measure the level of antibodies that the women produced in response to the vaccination. Cortisol levels were measured from plasma samples pre- and post-vaccination. Women from wealthier families had lower cortisol levels, and women from the highest family income group had the highest levels of antibody titers against hepatitis B vaccine. No significant relationships were observed between cortisol level and immune function, nor between family income and height. The results show that income level during ontogeny is associated with the strength of immune response and with psychoneuroendocrine pathways underlying stress perception in early adulthood. The findings indicate that the quality of the developmental niche is associated with the condition-dependent expression of immune function and stress response.

Network-regulated organ allometry: The developmental regulation of morphological scaling

Morphological scaling relationships, or allometries, describe how traits grow coordinately and covary among individuals in a population. The developmental regulation of scaling is essential to generate correctly proportioned adults across a range of body sizes, while the mis-regulation of scaling may result in congenital birth defects. Research over several decades has identified the developmental mechanisms that regulate the size of individual traits. Nevertheless, we still have poor understanding of how these mechanisms work together to generate correlated size variation among traits in response to environmental and genetic variation. Conceptually, morphological scaling can be generated by size-regulatory factors that act directly on multiple growing traits (trait-autonomous scaling), or indirectly via hormones produced by central endocrine organs (systemically regulated scaling), and there are a number of well-established examples of such mechanisms. There is much less evidence, however, that genetic and environmental variation actually acts on these mechanisms to generate morphological scaling in natural populations. More recent studies indicate that growing organs can themselves regulate the growth of other organs in the body. This suggests that covariation in trait size can be generated by network-regulated scaling mechanisms that respond to changes in the growth of individual traits. Testing this hypothesis, and one of the main challenges of understanding morphological scaling, requires connecting mechanisms elucidated in the laboratory with patterns of scaling observed in the natural world. This article is categorized under: Establishment of Spatial and Temporal Patterns > Regulation of Size, Proportion, and Timing Comparative Development and Evolution > Organ System Comparisons Between Species.

Trends in BMI among elderly Japanese population: findings from 1973 to 2016 Japan National Health and Nutrition Survey

OBJECTIVE

To examine 44-year trends in height, weight and BMI, and the prevalence of overweight/obesity and underweight in the elderly Japanese population because Japan, the country with the longest life expectancy, has the highest ageing population.

DESIGN

Using the nationally representative cumulative data from the Japan National Health and Nutrition Survey 1973-2016, sex-specific and age-adjusted mean height, weight and BMI, and the prevalence of overweight/obesity and underweight were calculated for each year. Trend analyses were performed using the Joinpoint Regression Program. Next, changes in height, weight and BMI, and the prevalence of overweight/obesity and underweight were estimated for each age group (65-69, 70-79 and >80 years) according to the birth year groups.

SETTING

Japan.

PARTICIPANTS

Individuals aged ≥65 years with complete data on height and body weight measurements (N 94 508).

RESULTS

Trends in average height and weight increased over the four decades in both men and women. The prevalence of overweight/obesity dramatically increased and nearly tripled in men, accompanied with significantly decreased underweight prevalence. Furthermore, the increasing trend in average BMI and overweight/obesity prevalence in women reached a peak in 2002 and showed a decreasing trend thereafter, while a downward trend in underweight prevalence showed a gradual increase in women since 2003.

CONCLUSIONS

Trends in height, weight and BMI among the elderly population should continue to be closely monitored in parallel with the effects of dietary changes, energy intake and physical activity (step counts).

"I'm not a freshi": Culture shock, puberty and growing up as British-Bangladeshi girls

Early puberty is a risk factor for adult diseases and biomedical and psychosocial research implicate growth (in height and weight) and stress as modifiable drivers of early puberty. Seldom have studies examined these drivers simultaneously or concurrently using quantitative and qualitative methods. Within the context of migration, we used mixed-methods to compare growth, stress and puberty in a study of 488 girls, aged 5–16, who were either Bangladeshi, first-generation migrant to the UK, second-generation migrant, or white British (conducted between 2009 and 2011). Using a biocultural framework, we asked the questions: 1) Does migration accelerate pubertal processes? 2) What biocultural markers are associated with migration? 3) What biocultural markers are associated with puberty? Girls self-reported pubertal stage, recalled 24-h dietary intake, and answered questions relating to dress, food, and ethnic identity. We collected anthropometrics and assayed saliva specimens for dehydroepiandrosterone-sulfate (DHEA-S) to assess adrenarcheal status. Our findings demonstrate that first-generation migrants had earlier puberty than second-generation migrants and Bangladeshi girls. British style of dress did not increase with migration, while dietary choices did, which were reflected in increasing body mass index. However, the widely-used phrase, “I'm proud of my religion, but not my culture” demonstrated that ethnic identity was aligned more with Islamic religion than ‘Bangladeshi culture.’ This was epitomized by wearing the hijab, but denial of eating rice. The social correlates of puberty, such as ‘practicing’ wearing the hijab and becoming ‘dedicated to the scarf,’ occurred at the same ages as adrenarche and menarche, respectively, among first-generation girls. We suggest that the rejection of ‘Bangladeshi culture’ might be a source of psychosocial stress for first-generation girls, and this may explain elevated DHEA-S levels and early puberty compared to their second-generation counterparts. Our results support a biocultural model of adolescence, a period for biological embedding of culture, when biological and psychosocial factors adjust developmental timing with potential positive and negative implications for long-term health.

•

Compares puberty in migrant Bangladeshi girls in the UK using mixed-methods.

•

Argues that stigma may explain early maturation in first-generation migrants.

•

Reveals overlapping ages of biological and cultural puberty in migrant girls.

•

Generates new biocultural hypotheses via hormonal, growth and social stigma data.

Preferences for Sexually Dimorphic Body Characteristics Revealed in a Large Sample of Speed Daters

While hundreds of studies have investigated the indices that make up attractive body shapes, these studies were based on preferences measured in the laboratory using pictorial stimuli. Whether these preferences translate into real-time, face-to-face evaluations of potential partners is unclear. Here, 539 (275 female) participants in 75 laboratory-based sessions had their body dimensions measured before engaging in round-robin speed dates. After each date, they rated each other’s body, face, personality, and overall attractiveness and noted whether they would go on a date with the partner. Women with smaller waists and lower waist-to-hip ratios were found most attractive, and men with broader shoulders and higher shoulder-to-waist (or hips) ratios were found most attractive. Taller individuals were preferred by both sexes. Our results show that body dimensions associated with greater health, reproductive value (in women), and formidability (in men) influence face-to-face evaluations of attractiveness, consistent with a role of intersexual selection in shaping human bodies.

Nutrition status in adult Chilean population: economic, ethnic and sex inequalities in a post-transitional country

OBJECTIVE

To assess the relationship between malnutrition, socioeconomic status (SES) and ethnicity in Chilean adult population.

DESIGN

Nationally representative survey (ENS) conducted in 2016-2017. Sociodemographic information, weight, height and hemoglobin (Hb) were measured (2003 ENS). Excess weight was defined as BMI ≥25 kg/m2. Undernutrition included underweight (BMI <18·5 kg/m2), short stature (height <1·49 m in women and <1·62 m in men) or anaemia (Hb <12 g/l). Education and household income level were used as indicators of SES; ethnicity was self-reported. We applied linear combinations of estimators to compare the prevalence of excess weight and undernutrition by SES and ethnicity.

SETTING

Chile.

PARTICIPANTS

In total, 5082 adults ≥20 years (64 % women) and 1739 women ≥20 years for anaemia analyses.

RESULTS

Overall, >75 % of women and men had excess weight. Low SES women either by income or education had higher excess weight ((82·0 (77·1, 86·1) v. 65·0 (54·8, 74·1)) by income; (85·3 (80·6, 89·0) v. 68·2 (61·6, 74·1) %) by education) and short stature (20-49 years; 31(17·9, 48·2) v. 5·2 (2·2,11·4) by education); obesity was also more frequent among indigenous women (20-49 years; 55·8 (44·4, 66·6) v. 37·2 (32·7, 42·0) %) than non-indigenous women. In men, excess weight did not significantly differ by SES or ethnicity, but short stature concentrated in low SES (20-49 years; 47·6 (24·6, 71·6) v. 4·5 (2·1, 9·5) by education) and indigenous men (21·5 (11·9, 5·5, 11·9) v. 8·2 (5·5, 11·9)) (P < 0·05 for all).

CONCLUSIONS

In Chile, malnutrition is disproportionately concentrated among women of low SES and indigenous origin; these inequalities should be considered when implementing prevention policies.

A lex naturalis delineates components of a human-specific, adrenal androgen-dependent, p53-mediated 'kill switch' tumor suppression mechanism

We have recently described in this journal our detection of an anthropoid primate-specific, adrenal androgen-dependent, p53-mediated, 'kill switch' tumor suppression mechanism that reached its fullest expression only in humans, as a result of human-specific exposure to polycyclic aromatic hydrocarbons caused by the harnessing of fire - but which has components reaching all the way back to the origin of the primate lineage. We proposed that species-specific mechanisms of tumor suppression are a generalized requirement for vertebrate species to increase in body size or lifespan beyond those of species basal to their lineage or to exploit environmental niches which increase exposure to carcinogenic substances. Using empirical dynamic modeling, we have also reported our detection of a relationship between body size, lifespan, and species-specific mechanism of tumor suppression (and here add carcinogen exposure), such that a change in any one of these variables requires an equilibrating change in one or more of the others in order to maintain lifetime cancer risk at a value of about 4%, as observed in virtually all larger, longer-lived species under natural conditions. Here we show how this relationship, which we refer to as the lex naturalis of vertebrate speciation, elucidates the evolutionary steps underlying an adrenal androgen-dependent, human-specific 'kill switch' tumor suppression mechanism; and further, how it prescribes a solution to 'normalize' lifetime cancer risk in our species from its current aberrant 40% to the 4% that characterized primitive humans. We further argue that this prescription writ by the lex naturalis represents the only tenable strategy for meaningful suppression of the accelerating impact of cancer upon our species.

Secular decline in limb bone strength among South African Africans during the 19th and 20th centuries

OBJECTIVES

South African Africans have been reported to have experienced negative or null secular trends in stature and other measures of skeletal structure across the 19th and 20th centuries, presumably due to poor living conditions during a time of intensifying racial discrimination. Here, we investigate whether any secular trend is apparent in limb bone strength during the same period.

MATERIALS AND METHODS

Cadaver-derived skeletons (n = 221) were analyzed from female and male South African Africans who were born between 1839 and 1970, lived in and around Johannesburg, and died between 1925 and 1991 when they were 17-90 years of age. For each skeleton, a humerus and femur were scanned using computed tomography, and mid-diaphyseal cross-sectional geometric properties were calculated and scaled according to body size.

RESULTS

In general linear mixed models accounting for sex, age at death, and skeletal element, year of birth was a significant (p < .05) negative predictor of size-standardized mid-diaphyseal cortical area (a proxy for resistance to axial loading) and polar moment of area (a proxy for resistance to bending and torsion), indicating a temporal trend toward diminishing limb bone strength. No significant interactions were detected between year of birth and age at death, suggesting that the decline in limb bone strength was mainly due to changes in skeletal maturation rather than severity of age-related bone loss.

DISCUSSION

Limb bone strength is thus potentially another feature of the skeletal biology of South African Africans that was compromised by poor living conditions during the 19th and 20th centuries.

Inhaled corticosteroid-phobia and childhood asthma: Current understanding and management implications

Asthma is the most prevalent chronic disease in children. Inhaled corticosteroids (ICS) is the first-line controller therapy for children with persistent asthma, however, suboptimal compliance to ICS therapy remains as a major obstacle in paediatric asthma management. Steroid-phobia, the fear of side-effects and subsequent aversion of ICS, has been widely reported in parents of asthmatic children. The reported prevalence of steroid-phobia varies widely from 19% to 67% in different populations. The concerns about ICS frequently raised by parents include growth suppression, weight gain, bone weakness, addiction and psychiatric disturbances. Outside of growth suppression, which is statistically significant yet mild in clinical studies, the other concerns are not evidence-based and are misconceptions. Conflicting results have been reported regarding the impact of steroid-phobia on ICS compliance. In contrast, steroid-phobia has consistent and negative effects on asthma control in children. While asthma educational programmes have demonstrable benefits in general paediatric populations, the generalisability of such programmes to steroid-phobic parents remains undetermined. There is a paucity of data on specific educational programmes to clear misconceptions and reduce steroid-phobia. Given the continually raising prevalence of paediatric asthma, high-quality studies are warranted to investigate the prevalence and impact of steroid-phobia, with an ultimate goal of developing effective strategies to tackle steroid-phobia and improve asthma care in children.