Is leg length a biomarker of childhood conditions in older Chinese women? The Guangzhou Biobank Cohort Study

Age at Menarche Is Associated With Leg-Length Components Among the Adolescent Girls in West Bengal, India

BACKGROUND

The relationship between early age at menarche (AAM) and body height (HT), including its different segments has not been extensively studied among non Western populations. Lengths of the lower (distal) part of the leg, such as knee HT (KH) and tibial length (TbL), are considered to be sensitive indicators of living conditions during early growth and development. Life history theory predicts that within a survival challenge the growth of vital parts of the body shall be prioritized over less essential parts. The present study hypothesized that earlier age at menarche would be associated with shorter tibial length in resource constrained settings.

AIM

To investigate the potential associations of menarcheal age with HT, KH, TbL, and other linear components of HT among the Bengalee schoolgirls aged 10-13 years.

METHODS

Among the 208 girls aged 10-13 years, menarcheal status and age at menarche were determined by status quo and retrospective methods, respectively. Lower leg length was represented by two measures, KH and the supracutaneous measure of TbL. The differences in HT, sitting HT (SH), total leg length (LL), thigh length (TL), KH, and TbL, between pre-menarcheal-(PMG) and post-menarcheal girls (POMG), as well as between earlier menarcheal-(EMG) and later menarcheal girls (LMG), were assessed by student t-test and analysis of covariance.

RESULTS

The POMG were heavier, taller and had higher adiposity than their PMG peers, without showing any significant age-difference. HT, knee HT, TbL, and TbL to HT ratio showed significant differences between the EMG and LMG. The EMG showed lower values for all of those measures and the strongest difference was observed for TbL. However, there were no significant differences in SH and SHR between EMG and LMG.

CONCLUSIONS

The study indicated a possible effect of early AAM on growth of distal body parts in a resource poor socioeconomic condition. Further studies on the relationship between growth and AAM among different populations living in different socio-ecological conditions could be worth conducting.

The effect of different socio-economic and working conditions on body size and proportions: A case study on adults from Samsun, Turkey

Conditions in the early stages of life shape body size and proportions. This study includes individuals who came from different socio-economic conditions and worked in physically demanding jobs in childhood. By determining the body sizes of these individuals and evaluating the proportional relationships between several groups, the goal was to understand the effect levels of socio-economic levels and working conditions on the body. For this purpose, an anthropometric study was conducted on 623 males and females between the ages of 20 and 45 living in Samsun, Turkey. The study sample consisted of four different groups. It was divided into two main groups of high and low socio-economic level, and the low socio-economic group was divided into two subgroups of heavy-worker and nonheavy-worker. The results demonstrated that socio-economic differences in the size and proportions of the individuals were statistically significant (p<0.05). The high socio-economic group had the highest values in all measures. External factors affected the lower limbs more than the upper limbs. The measurement most affected by these factors was leg length. Longer legs characterized the high socio-economic group, while longer arms characterized both low socio-economic groups. The relative differences observed can be said to derive from the distal limbs. This finding was valid for both sexes. The average values were close to each other in the low socio-economic group, for which the aim was to comprehend the effects of heavy working conditions. However, differences in proportional relationships were more significant. In this context, it was seen that heavy labour also affected growth, in addition to the well-known factors encountered during the growth period, such as nutrition, health, and illness. The observed changes were more significant in males than in females. Thus, it can be said that males were more affected by physiological and physical conditions.

Evolutionary life history theory as an organising framework for cohort studies: insights from the Cebu Longitudinal Health and Nutrition Survey

By tracking a group of individuals through time, cohort studies provide fundamental insights into the developmental time course and causes of health and disease. Evolutionary life history theory seeks to explain patterns of growth, development, reproduction and senescence, and inspires a range of hypotheses that are testable using the longitudinal data from cohort studies. Here we review two decades of life history theory-motivated work conducted in collaboration with the Cebu Longitudinal Health and Nutrition Survey (CLHNS), a birth cohort study that enrolled more than 3000 pregnant women in the Philippines in 1983 and has since followed these women, their offspring and grandoffspring. This work has provided evidence that reproduction carries "costs" to cellular maintenance functions, potentially speeding senescence, and revealed an unusual form of genetic plasticity in which the length of telomeres inherited across generations is influenced by reproductive timing in paternal ancestors. Men in Cebu experience hormonal and behavioural changes in conjunction with changes in relationship and fatherhood status that are consistent with predictions based upon other species that practice bi-parental care. The theoretical expectation that early life cues of mortality or environmental unpredictability will motivate a "fast" life history strategy are confirmed for behavioural components of reproductive decision making, but not for maturational tempo, while our work points to a broader capacity for early life developmental calibration of systems like immunity, reproductive biology and metabolism. Our CLHNS findings illustrate the power of life history theory as an integrative, lifecourse framework to guide longitudinal studies of human populations.

Testing for paternal influences on offspring telomere length in a human cohort in the Philippines

OBJECTIVES

Telomeres, emerging biomarkers of aging, are comprised of DNA repeats located at chromosomal ends that shorten with cellular replication and age in most human tissues. In contrast, spermatocyte telomeres lengthen with age. These changes in telomere length (TL) appear to be heritable, as older paternal ages of conception (PAC) predict longer offspring TL. Mouse-model studies raise questions about the potential for effects of paternal experiences on human offspring TL, as they suggest that smoking, inflammation, DNA damage, and stressors all shorten sperm TL. Here, we examined whether factors from the paternal environment predict offspring TL as well as interact with PAC to predict offspring TL.

MATERIALS AND METHODS

Using data from the Philippines, we tested if smoking, psychosocial stressors, or shorter knee height (a measure of early life adversity) predict shorter offspring TL. We also tested if these interacted with PAC in predicting offspring TL.

RESULTS

While we did not find the predicted associations, we observed a trend toward fathers with shorter knee height having offspring with longer TL. In addition, we found that knee height interacted with PAC to predict offspring TL. Specifically, fathers with shorter knee heights showed a stronger positive effect of PAC on offspring TL.

DISCUSSION

While the reasons for these associations remain uncertain, shorter knee height is characteristic of earlier puberty. Since spermatocyte TL increases with the production of sperm, we speculate that individuals with earlier puberty, and its concomitant commencement of production of sperm, had more time to accumulate longer sperm telomeres.

Life history trade-offs and the partitioning of maternal investment: Implications for health of mothers and offspring

Lay Summary: This review sets out the hypothesis that life history trade-offs in the maternal generation favour the emergence of similar trade-offs in the offspring generation, mediated by the partitioning of maternal investment between pregnancy and lactation, and that these trade-offs help explain widely reported associations between growth trajectories and NCD risk. Growth patterns in early life predict the risk of non-communicable diseases (NCDs), but adaptive explanations remain controversial. It is widely assumed that NCDs occur either because of physiological adjustments to early constraints, or because early ecological cues fail to predict adult environmental conditions (mismatch). I present an inter-generational perspective on developmental plasticity, based on the over-arching hypothesis that a key axis of variability in maternal metabolism derives from life history trade-offs, which influence how individual mothers partition nutritional investment in their offspring between pregnancy and lactation. I review evidence for three resulting predictions: (i) Allocating relatively more energy to growth during development promotes the capacity to invest in offspring during pregnancy. Relevant mechanisms include greater fat-free mass and metabolic turnover, and a larger physical space for fetal growth. (ii) Allocating less energy to growth during development constrains fetal growth of the offspring, but mothers may compensate by a tendency to attain higher adiposity around puberty, ecological conditions permitting, which promotes nutritional investment during lactation. (iii) Since the partitioning of maternal investment between pregnancy and lactation impacts the allocation of energy to 'maintenance' as well as growth, it is expected to shape offspring NCD risk as well as adult size and body composition. Overall, this framework predicts that life history trade-offs in the maternal generation favour the emergence of similar trade-offs in the offspring generation, mediated by the partitioning of maternal investment between pregnancy and lactation, and that these trade-offs help explain widely reported associations between growth trajectories and NCD risk.

Association of maternal menarcheal age with anthropometric dimensions and blood pressure in children from Greater Bilbao

BACKGROUND

Earlier menarche has been related to shorter height and greater obesity-related anthropometric dimensions and blood pressure in women. Boys and girls with earlier maternal menarcheal age (MMA) have shown greater height and body mass index (BMI) in childhood.

AIM

To analyse associations of menarcheal age with their own and their children's anthropometric dimensions and blood pressure.

SUBJECTS AND METHODS

The sample consisted of 493 women and their children (aged 2-19 years) from Greater Bilbao (Basque Country, Spain). For both generations there is information on 19 anthropometric dimensions, blood pressure and socio-demographic characteristics. Linear regressions adjusted for different covariates were used to analyse the associations.

RESULTS

Menarcheal age in women showed the greatest positive associations with iliospinal height and ectomorphy and negative associations with BMI, sum of six skin-folds, endomorphy and mesomorphy. Boys with earlier MMA had greater body heights and breadths, particularly iliospinal height and biacromial breadth (0.10 z-score/year; p < 0.05). In girls, earlier MMA predicted greater sitting height, biepicondylar humerus breadth, weight and sum of four circumferences (0.07-0.09 z-score/year; p < 0.05). However, there was some evidence that MMA was positively associated with body heights, ectomorphy and blood pressure in girls aged ≥12.

CONCLUSION

Children with earlier MMA tend to have greater anthropometric dimensions. Adolescent growth spurt might affect these relationships, at least in girls.

Grandparental education, parental education and child height: evidence from Hong Kong's "Children of 1997" birth cohort

PURPOSE

Adult height is the sum of growth during fetal, infancy, childhood, and puberty, controlled by different biological factors. In long-term developed Western populations, height is positively associated with socioeconomic position, but less clearly so in recently developing populations. We aimed to elucidate socioeconomic influences on height at different growth phases.

METHODS

We examined the associations of parents' education and grandparents' education with birth weight and height gain z-scores during infancy (birth to <2 years), childhood (2 to <8 years), and puberty (8 to <14 years) adjusted for parents' height using generalized estimating equations in Hong Kong's "Children of 1997" birth cohort (n = 8264).

RESULTS

Parents' education, but not grandparents', was positively associated with birth weight (z-score, 0.07; 95% confidence interval [CI] 0.01-0.12 for grade ≥12 compared with grade ≤9) and height gain during infancy (0.11; 95% CI, 0.05-0.18), adjusted for gender, gestational age, initial size, parity, parents' age, parents' birthplace, and parents' height. Conversely, similarly adjusted, grandparents' education, but not parents', was associated with height gain during childhood (0.11; 95% CI, 0.04-0.18).

CONCLUSIONS

Parental education was associated with fetal and infant, but not childhood, linear growth, suggesting the mechanism underlying socioeconomic influences on height at different growth phases may be contextually specific.

Trade-offs in relative limb length among Peruvian children: extending the thrifty phenotype hypothesis to limb proportions

Background and Methods

Both the concept of ‘brain-sparing’ growth and associations between relative lower limb length, childhood environment and adult disease risk are well established. Furthermore, tibia length is suggested to be particularly plastic under conditions of environmental stress. The mechanisms responsible are uncertain, but three hypotheses may be relevant. The ‘thrifty phenotype’ assumes that some components of growth are selectively sacrificed to preserve more critical outcomes, like the brain. The ‘distal blood flow’ hypothesis assumes that blood nutrients decline with distance from the heart, and hence may affect limbs in relation to basic body geometry. Temperature adaptation predicts a gradient of decreased size along the limbs reflecting decreasing tissue temperature/blood flow. We examined these questions by comparing the size of body segments among Peruvian children born and raised in differentially stressful environments. In a cross-sectional sample of children aged 6 months to 14 years (n = 447) we measured head circumference, head-trunk height, total upper and lower limb lengths, and zeugopod (ulna and tibia) and autopod (hand and foot) lengths.

Results

Highland children (exposed to greater stress) had significantly shorter limbs and zeugopod and autopod elements than lowland children, while differences in head-trunk height were smaller. Zeugopod elements appeared most sensitive to environmental conditions, as they were relatively shorter among highland children than their respective autopod elements.

Discussion

The results suggest that functional traits (hand, foot, and head) may be partially protected at the expense of the tibia and ulna. The results do not fit the predictions of the distal blood flow and temperature adaptation models as explanations for relative limb segment growth under stress conditions. Rather, our data support the extension of the thrifty phenotype hypothesis to limb growth, and suggest that certain elements of limb growth may be sacrificed under tough conditions to buffer more functional traits.

A prospective study of childhood social hardships and age at menarche

PURPOSE

To determine the role of type, timing, and cumulative childhood hardships on age at menarche in a prospective cohort study.

METHODS

A longitudinal analysis was undertaken of 4524 female participants of the National Child Development Study cohort (1958-2003). Six types of childhood hardships were identified with a factor analysis methodology. Paternal absence/low involvement in childhood was an a priori hardship. Retrospective reports of abuse in childhood also were explored in relation to age at menarche. Generalized logit regression analyses explored the impact of type, timing, and cumulative hardships on age at menarche (≤ 11, 12-13, ≥ 14 years).

RESULTS

Cumulative childhood hardships were associated with a graded increase in risk for later menarche with adjusted odds ratio [AOR] of 1.37 (95% confidence interval [95% CI], 1.10-1.70), 1.50 (95% CI, 1.18-1.91), and 1.58 (95% CI, 1.29-1.92) among those with two, three, and four or more adversities, respectively. More than two hardships in early life had the strongest association with late menarche (AOR, 2.32; 95% CI, 1.12-4.80). Sexual abuse was most strongly associated with early menarche (AOR, 2.60; 95% CI, 1.40-4.81).

CONCLUSIONS

Cumulative childhood hardships increased risk for later age at menarche. Child abuse was associated with both early and late menarche, although associations varied by type of abuse.

Maternal education inequalities in height growth rates in early childhood: 2004 Pelotas birth cohort study

Socio-economic inequalities in attained height have been reported in many countries. The aim of this study was to explore the age at which maternal education inequalities in child height emerge among children from a middle-income country. Using data from the 2004 Pelotas cohort study from Brazil we modelled individual height growth trajectories in 2106 boys and 1947 girls from birth to 4 years using a linear spline mixed-effects model. We examined the associations of maternal education with birth length and trajectories of growth in length/height, and explored the effect of adjusting for a number of potential confounder or mediator factors. We showed linear and positive associations of maternal education with birth length and length/height growth rates at 0-3 months and 12-29/32 months with very little association at 3-12 months, particularly in boys. By age 4 years the mean height of boys was 101.06 cm (SE = 0.28) in the lowest and 104.20 cm (SE = 0.15) in the highest education category (mean difference 3.14 cm, SE = 0.32, P < 0.001). Among girls the mean height was 100.02 cm (SE = 0.27) and 103.03 cm (SE = 0.15) in the lowest and highest education categories, respectively (mean difference 3.01 cm, SE = 0.31, P < 0.001). For both boys and girls there was on average a 3-cm difference between the extreme education categories. Adjusting for maternal height reduced the observed birth length differences across maternal education categories, but differences in postnatal growth rates persisted. Our data demonstrate an increase in the absolute and relative inequality in height after birth; inequality increases from approximately 0.2 standard deviations of birth length to approximately 0.7 standard deviations of height at age 4, indicating that height inequality, which was already present at birth, widened through differential growth rates to age 2 years.

Age at menarche, the leg length to sitting height ratio, and risk of diabetes in middle-aged and elderly Chinese men and women

AIMS

To evaluate the associations of age at menarche and the leg length-to-sitting-height ratio, markers of adolescent growth, with risk of diabetes in later life.

MATERIALS AND METHODS

Information from 69,385 women and 55,311 men, aged 40-74 years from the Shanghai Women's Health Study and Shanghai Men's Health Study, were included in the current analyses. Diabetes status was ascertained through biennial in person follow-up. Cox models, with age as the time scale, were used.

RESULTS

There were 2369 cases of diabetes (1831 women; 538 men) during an average of 7.3 and 3.6 years of follow-up of the women and men, respectively. In females, menarche age was inversely associated with diabetes risk after adjustment for birth cohort, education, and income (HR = 0.95, 0.92-0.98). In both genders, leg length-to-sitting-height ratio was inversely related to diabetes (HR = 0.88, 0.80-0.97 for men; HR = 0.91, 0.86-0.96 for women) after adjustment for birth cohort, education, and income. Further adjustment for adult BMI at study enrollment completely eliminated the associations of age at menarche (HR = 0.99, 0.96-1.02) and the leg length-to-sitting-height ratio (HR = 1.00, 0.91-1.10 for men; HR = 1.01, 0.96-1.07 for women) with diabetes risk.

CONCLUSIONS

Our study suggests that markers of an early age at peak height velocity, i.e. early menarche age and low leg-length-to-sitting height ratio, may be associated with diabetes risk later in life and this association is likely to be mediated through obesity.

Is relative leg length a biomarker of childhood nutrition? Long-term follow-up of the Hyderabad Nutrition Trial

BACKGROUND

Relative leg length is frequently used as a biomarker of childhood nutrition in epidemiological studies, but evidence is lacking. We examined the association between supplemental nutrition in pregnancy and childhood and relative proportions of components of height in adolescence.

METHODS

In a community trial of nutritional supplementation, villages from adjacent administrative areas were selected to serve as intervention (n = 15) and control (n = 14) arms. In the intervention villages, balanced protein-calorie supplementation (2.51 MJ, 20 g protein) was offered daily to pregnant women and their offspring until the age of 6 years. Children born in the trial were re-examined 15 years later to assess components of height.

RESULTS

A total of 1165 adolescents (intervention: 654, 49% of trial participants; control: 511, 41% of trial participants) aged 13-18 years were examined. Supplemented children were 10 mm taller [95% confidence interval (CI): 1.4 to 18.7 mm], but almost all of the increase was in trunk length (9 mm, 95% CI: 2.6 to 15.4 mm). The age- and gender-adjusted β-coefficients for the association of nutritional supplementation with relative trunk, leg and lower leg lengths (expressed as standard deviation scores) were 0.26 (95% CI: 0.11 to 0.42), 0.08 (95% CI: -0.03 to 0.19) and 0.03 (95% CI: -0.08 to 0.15) respectively, thereby unsupportive of cephalocaudal gradient in growth.

CONCLUSIONS

In this nutritional supplementation trial in an undernourished population, we were unable to confirm relative leg length as a biomarker of childhood nutrition. Alternative explanations may underlie the reported associations between childhood conditions and relative leg length.

Estimated birth weight and adult cardiovascular risk factors in a developing southern Chinese population: a cross sectional study

Background

Birth weight is negatively associated with cardiovascular diseases and diabetes, but the associations are less well-established in developing populations where birth weight is often unavailable. We studied the association of birth weight and cardiovascular risk, using birth rank as an instrumental variable, in Southern China.

Methods

We used published data on birth weight by birth rank from an appropriate population and baseline data from the Guangzhou Biobank Cohort Study phases 2 & 3 (2005-8) to examine the adjusted associations, using instrumental variable analysis, of birth weight with clinically measured cardiovascular risk factors and the metabolic syndrome in older (≥ 50 years) men (n = 5,051) and women (n = 13,907).

Results

Estimated birth weight was associated with lower blood pressure (systolic -0.25 mm Hg 95% confidence interval (CI), -0.53 to 0.03 and diastolic -0.33 mm Hg 95% CI -0.48 to -0.18 per standard deviation higher birth weight), but had little association with glucose, lipids, waist-hip ratio, body mass index or the metabolic syndrome, adjusted for age, sex, early environment and number of offspring.

Conclusion

Birth weight may impact blood pressure; however associations of birth weight with other cardiovascular risk factors may not be related to foetal exposures, but speculatively could be an historical co-incidence, with corresponding implications for prevention.

Leg length, body proportion, and health: a review with a note on beauty

Decomposing stature into its major components is proving to be a useful strategy to assess the antecedents of disease, morbidity and death in adulthood. Human leg length (femur + tibia), sitting height (trunk length + head length) and their proportions, for example, (leg length/stature), or the sitting height ratio (sitting height/stature x 100), among others) are associated with epidemiological risk for overweight (fatness), coronary heart disease, diabetes, liver dysfunction and certain cancers. There is also wide support for the use of relative leg length as an indicator of the quality of the environment for growth during infancy, childhood and the juvenile years of development. Human beings follow a cephalo-caudal gradient of growth, the pattern of growth common to all mammals. A special feature of the human pattern is that between birth and puberty the legs grow relatively faster than other post-cranial body segments. For groups of children and youth, short stature due to relatively short legs (i.e., a high sitting height ratio) is generally a marker of an adverse environment. The development of human body proportions is the product of environmental x genomic interactions, although few if any specific genes are known. The HOXd and the short stature homeobox-containing gene (SHOX) are genomic regions that may be relevant to human body proportions. For example, one of the SHOX related disorders is Turner syndrome. However, research with non-pathological populations indicates that the environment is a more powerful force influencing leg length and body proportions than genes. Leg length and proportion are important in the perception of human beauty, which is often considered a sign of health and fertility.

Early life circumstances and their impact on menarche and menopause

Ages at menarche and menopause have been shown to be associated with adverse health outcomes in later life. For example, earlier menarche and later menopause have been independently linked to higher risk of breast cancer. Earlier menarche may also be associated with an increased risk of endometrial cancer, menstrual problems and adult obesity. Given the associations of ages at menarche and menopause with future health outcomes, it is important to establish what factors across life, and generations, may influence these. This article examines the associations of early life factors, namely birthweight, bodyweight and growth during childhood, childhood socioeconomic circumstances and psychosocial factors with ages at menarche and menopause. It examines possible explanations of the associations found, including life history theory, and discusses areas for future research.