Growth in some physical dimensions in relation to adolescent growth spurt among rural Indian children

Growth Velocity in South Indian Children Between Three and 18 Years of Age

Objective Height velocity is a crucial anthropometric parameter for the evaluation of mild- or recent-onset short stature; however, there is no data on height velocity in South Indian children. We undertook this study to establish the normative data. Methods This prospective longitudinal study included 3327 apparently healthy children aged three to 18 years from government and private schools of Krishna district, Andhra Pradesh. Height and weight were measured at baseline and three-monthly intervals for one year (October 2018 to October 2019). Results Age- and sex-specific height velocity percentiles were generated. The data was available in 1627 boys and 1700 girls. The mean peak height velocity (PHV) was 7.18±2.56 cm in boys observed at 12-12.9 years and 5.8±2.56 cm in girls at 10-10.9 years. Conclusion Normative height velocity data for South Indian children has been presented.

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.

The impact of residual growth on deformity progression

Idiopathic scoliosis is a disease of the growing spine. Risk of progression and aggravation of disease are mainly dictated by the remaining growth and curve magnitude. Remaining growth can be estimated by repeated biometric measurements, tanner sign and bone age estimation. Puberty is the turning point in the natural history of this disease. The first two years following puberty are the turning point in the natural history of this disease since 90% of growth occurs during this period. Lateral olecranon radiograph is effective for estimating bone age during this phase. Growth acceleration is followed by a deceleration phase of three years where menarche occurs. Bone age during this phase is evaluated by hand X-rays and the Risser sign. Progression risk assessment of idiopathic scoliosis showed that a 30° curve at the beginning of puberty together with 20° to 30° curves with more than 10° of annual curve progression has a 100% risk of progression towards the 45° surgical threshold. In these patients, anticipation may be the key for effective treatment strategy. Treating these curves earlier than the surgical threshold before increased stiffness would lead to a better outcome.

Height Velocity in Apparently Healthy North Indian School Children

OBJECTIVE

Linear growth is best estimated by serial anthropometric data or height velocity (HV). In the absence of recent data on growth velocity, we undertook to establish normative data in apparently healthy North Indian children.

MATERIALS AND METHODS

Prospective longitudinal study in a representative sample of 7710 apparently healthy children, aged 3-17 years from different regions of Delhi. Height was measured at baseline and at 12 months while pubertal examination was performed at baseline in a subset of children.

RESULTS

The data on HV and puberty were available in 5635 participants (73.08%; 2341 boys and 3294 girls) and 1553 participants (622 boys; and 931 girls), respectively. The mean peak height velocity (PHV) was 7.82 ± 2.60 cm in boys seen at 12-12.9 years and 6.63 ± 1.81 cm in girls at 10-10.9 years Although late maturing boys had a greater HV than early or normal maturers, it did not vary with the age of pubertal maturation in girls. HV correlated with parental height in prepubertal boys, girls, and pubertal boys (P < 0.01) while no correlation was seen in girls.

CONCLUSIONS

The study presents normal height velocities in North Indian children. A secular trend was observed in achieving PHV in both boys and girls.

Systematic review of birth cohort studies in South East Asia and Eastern Mediterranean regions

BACKGROUND

Few longitudinal studies of children have taken place in the developing world, despite child mortality being concentrated there. This review summarises the methodologies and main outcomes of longitudinal studies of pre-school children (0 to 59 months) in the World Health Organization's South East Asia (SEA) and Eastern Mediterranean (EM) Regions.

METHODS

A systematic search of literature using pre-defined criteria revealed 7863 papers. After application of quality criteria, 120 studies were selected for analysis.

RESULTS

The search revealed 83 studies in the SEA region and 37 in the EM region, of which 92 were community-based and 8 facility-based. Objectives were diverse but topics included growth (n = 49 studies), mortality (n = 28), nutrition (n = 24), and infectious diseases (n = 33). Only 12 studies focused on non-communicable diseases. Duration ranged from 7 to 384 months. Measurements included anthropometric (n = 56 studies), socioeconomic (n = 50) and biological sampling (n = 25), but only one study was DNA-based.

CONCLUSION

Biobanks have emerged as the most successful approach to generating knowledge about disease causes and mechanisms. Little of this is possible to undertake in the in SEA or EM regions, however. Further longitudinal studies of young children with DNA sampling should be set up to better understand determinants of diseases in low-income countries.

The growth of different body length dimensions is not predictive for the peak growth velocity of sitting height in the individual child

The aim of this study was to determine whether the differences in timing of the peak growth velocity (PGV) between sitting height, total body height, subischial leg length, and foot length can be used to predict whether the individual patient with adolescent idiopathic scoliosis is before or past his or her PGV of sitting height. Furthermore, ratios of growth of different body parts were considered in order to determine their value in prediction of the PGV of sitting height in the individual patient. Ages of the PGV were determined for sitting height (n = 360), total body height (n = 432), subischial leg length (n = 357), and foot length (n = 263), and compared for the whole group and for the individual child in particular. Furthermore, the ages of the highest and lowest ratios between the body length dimensions were determined and compared to the age of the PGV of sitting height. The mean ages of the highest and lowest ratios were significantly different from the mean age of the PGV of sitting height in 3 out of 12 ratios in girls and 8 out of 12 ratios in boys. The variation over children was large and the ratios were too small, leading to a too large influence of measurement errors. The mean ages of the PGV all differed significantly from the mean age of the PGV of sitting height. However, the variation over individual children of the age differences in PGV between body dimensions was large, and the differences in timing of the PGV were not useful to predict whether the individual child is before or past his or her PGV of sitting height.

Predicting growth and curve progression in the individual patient with adolescent idiopathic scoliosis: design of a prospective longitudinal cohort study

BACKGROUND

Scoliosis is present in 3-5% of the children in the adolescent age group, with a higher incidence in females. Treatment of adolescent idiopathic scoliosis is mainly dependent on the progression of the scoliotic curve. There is a close relationship between curve progression and rapid (spinal) growth of the patient during puberty. However, until present time no conclusive method was found for predicting the timing and magnitude of the pubertal growth spurt in total body height, or the curve progression of the idiopathic scoliosis.The goal of this study is to determine the predictive value of several maturity indicators that reflect growth or remaining growth potential, in order to predict timing of the peak growth velocity of total body height in the individual patient with adolescent idiopathic scoliosis. Furthermore, different parameters are evaluated for their correlation with curve progression in the individual scoliosis patient.

METHODS/DESIGN

This prospective, longitudinal cohort study will be incorporated in the usual care of patients with adolescent idiopathic scoliosis. All new patients between 8 and 17 years with adolescent idiopathic scoliosis (Cobb angle >10 degrees) visiting the outpatient clinic of the University Medical Center Groningen are included in this study. Follow up will take place every 6 months. The present study will use a new ultra-low dose X-ray system which can make total body X-rays. Several maturity indicators are evaluated like different body length dimensions, secondary sexual characteristics, skeletal age in hand and wrist, skeletal age in the elbow, the Risser sign, the status of the triradiate cartilage, and EMG ratios of the paraspinal muscle activity. Correlations of all dimensions will be calculated in relationship to the timing of the pubertal growth spurt, and to the progression of the scoliotic curve. An algorithm will be made for the optimal treatment strategy in the individual patient with adolescent idiopathic scoliosis.

DISCUSSION

This study will determine the value of many maturity indicators and will be useful as well for other clinicians treating children with disorders of growth. Since not all clinicians have access to the presented new 3D X-ray system or have the time to make EMG's, for example, all indicators will be correlated to the timing of the peak growth velocity of total body height and curve progression in idiopathic scoliosis. Therefore each clinician can chose which indicators can be used best in their practice.

TRIAL REGISTRATION NUMBER

NTR2048.

Growth and nutritional status of Bengali adolescent girls

OBJECTIVE

Assessment of the growth and nutritional status among healthy Bengali adolescent schoolgirls at peri-urban area.

METHODS

In this cross sectional study, sample consists of 527 school going adolescent girls, aged 10 to 18 years. The sample of the present study was collected from a peri-urban area (Duttapukur) of north 24 parganas district of West Bengal, India. Standard anthropometric measurements including linear, curvilinear and skinfold thickness were collected from each subject. Percentile curves and nutritional indices were used to determine the growth and nutritional status respectively.

RESULTS

The nature of distance curves and percentile curves of the body measurements showed a high rate of increase in 10-11 years of age group corresponding to an earlier adolescent growth spurt than average Indian girls. The adolescent girls in the current study were found to be significantly (p<0.0001) taller than Indian girls and heavier than both Indian and urban Bengali girls but slightly shorter than urban Bengali girls. They are significantly (p<0.0001) shorter and lighter than American girls, which also corresponded to 50(th) percentile curves. Age specific nutritional assessment shows different grades of malnutrition among them. Gomez's classification indicates about 60 % to 70 % adolescent girls show either moderate to mild malnutrition during their growth period. Both the indices of Waterlow's classification show least percentage of least malnutrition among the girls.

CONCLUSION

The growth pattern and nutritional status observed among adolescent girls in peri-urban situation show heterogeneity with respect to some anthropometric traits and in conformity with the growth pattern and nutritional status of urban girls.

Childhood stature and adult cancer risk: the Boyd Orr cohort

Cancer risk in adulthood may be influenced by aspects of childhood diet. In the absence of direct dietary data, indirect measures of childhood diet and nutritional status, such as anthropometric measurements, may be useful in investigating diet-cancer associations. Previous studies suggest that taller adults may have increased cancer risk. Peak growth for different anthropometric measures occurs at different times and so differential associations with cancer risk may indicate periods of development that are particularly important in determining future risk. 2,642 traced members of the Boyd Orr cohort had measures of foot length, shoulder breadth, height, and leg length made when they were aged 2-14 years; trunk length was derived from the difference between overall height and leg length. Subjects were followed-up over 59 years to determine all-cause (n = 547) and site-specific (n = 97 for lung, 69 breast, 59 colorectal, 33 prostate, 320 not related to smoking) cancer deaths and registrations. There were no strong associations between childhood anthropometric measurements and adult cancer risk. Odds ratios (ORs) were broadly consistent with a slight increase in risk with increasing childhood stature but no single measure was of particular importance. The strongest associations were seen for breast cancer (OR per standard deviation increase in foot length: 1.16 (95% CI: 0.90, 1.51), shoulder breadth: 1.16 (0.91, 1.49) and trunk: 1.26 (1.00, 1.60), and prostate cancer (OR for foot length: 1.22 (0.86, 1.75)). There was little effect of adjustment for confounding factors and very limited evidence that associations differed with measures made prior to the onset of puberty (comparing the associations in children aged <8 vs. 8+ years). There was no evidence that any of the five indicators of childhood growth was more strongly related to cancer risk than the other measures.

Heritability variations of morphometric traits in West Bengal (India) children aged 4-19 years: a mixed-longitudinal growth study

BACKGROUND

Longitudinal and semi-longitudinal growth studies on siblings reflecting heritability changes during growth are very scarce. Moreover, studies of variables other than height, weight and BMI are virtually non-existent.

AIM

The study compared changes in the heritability of six body lengths, four body breadths, and three indices between ages 4 and 19 years on the basis of a mixed-longitudinal sample of siblings, and examined whether heritability estimates change during the growth period. The data consisted of 238 brothers and 214 sisters from 134 middle-class nuclear families living in Kolkata (India). The analysis of sibling correlation was performed by maximum likelihood. The age-related patterns of heritabilities of the various traits were described by a cubic spline.

RESULTS

The heritability was very high and significant in most traits, and at all considered ages. Mean heritability in the 10 morphometric traits was 69.3%, which was higher than the heritability values for the three indices.

CONCLUSIONS

These results confirmed the existence of age-related trends in heritability of the considered morphometric traits. The sharp decline of the heritabilities at adolescence in most of the morphometric traits, and the acromio-iliac index in particular, may be due to the large inter-individual variation in the age at which the adolescent growth spurt is reached in both sexes.

Sexual dimorphism in foot length proportionate to stature

BACKGROUND

The preponderance of existing results suggests that, relative to stature, women have smaller feet than men. However, several investigations indicate that the relationship between foot length and stature may be curvilinear, a pattern that, due to the dimorphic nature of stature, would mask the true direction of pedal sexual dimorphism in published results.

AIM

The study aimed to determine whether proportionate foot length is sexually dimorphic and, if so, the nature of that dimorphism.

MATERIALS AND METHODS

Surveying genetically disparate populations (USA, Turkey, and Native North and Central American), we examined data from three previous anthropometric studies (Davis 1990, Parham et al. 1992, Ozaslan et al. 2003) and foot tracings from the Steggerda Collection at the US National Museum of Health and Medicine. Analyses explored sex differences in the ratio between foot length and stature, and tested for nonlinearity.

RESULTS

Although varying in degree across populations, proportionate to stature, female foot length is consistently smaller than male foot length.

CONCLUSION

Given the biomechanical challenges posed by pregnancy, smaller female proportionate foot length is somewhat surprising, as foot length affects dorsoventral stability. It is possible that the observed pattern reflects intersexual selection for small female foot size, a cue of youth and nulliparity.

Nutritional status of the Indian population

High prevalence of low birth weight, high morbidity and mortality in children and poor maternal nutrition of the mother continue to be major nutritional concerns in India. Although nationwide intervention programmes are in operation over two decades, the situation has not changed greatly. In addition, the Indian population is passing through a nutritional transition and is expected to witness higher prevalences of adult non-communicable diseases such as diabetes, hypertension and coronary heart disease according to the theory of 'fetal origin of adult disease'. Clearly, there is a need for examining several issues of nutritional significance for effective planning of interventions. In particular, maternal nutrition and fetal growth relationship, long term effects of early life undernutrition, interactions of prenatal nutritional experiences and postnatal undernutrition are some of the major issues that have been discussed in the present paper with the help of prospective data from various community nutrition studies carried out in the department.