Secular changes and predictors of adult height for 86 105 male and female members of the Thai Cohort Study born between 1940 and 1990

Secular trends and urban-rural disparities in height of Chinese adolescents aged 18 years from 1985 to 2019

OBJECTIVES

To examine the secular trends and urban-rural disparities in height of Chinese adolescents aged 18 years from 1985 to 2019.

METHODS

Data were extracted from the Chinese National Surveys on Students' Constitution and Health from 1985 to 2019, and the heights of a total of 76 554 boys and 75 908 girls aged 18 years were measured. The Mann-Kendall trend test was used to analyze the secular trends in height. Changes in different periods and urban-rural disparities were tested by z-tests and calculating the ratios of the coefficient of variation (CV) of height.

RESULTS

The height of Chinese boys and girls aged 18 years increased from 168.21 and 157.10 cm in 1985 to 172.15 cm and 160.11 cm in 2019, respectively, with a larger increase in rural areas. The secular trends in height were the largest for boys from 1995 to 2005 and for girls from 2014 to 2019, and the same results were observed in urban and rural areas. The urban-rural disparities for boys and girls decreased by 1.79 and 0.91 cm, respectively, with significant decreases for boys in all regions and for girls in the eastern region. The overall CVs of height increased by 0.13% and 0.25% for boys and girls, respectively, with the largest increase among rural girls.

CONCLUSIONS

The height of Chinese adolescents aged 18 years continued to increase between 1985 and 2019. The urban-rural disparities narrowed, and inequalities within rural areas for girls increased.

Body size and weight status of adult Indian males born in the 1890s-1950s: Age and secular change in the context of demographic, economic, and political transformation

OBJECTIVES

To evaluate secular change in body size and weight status of adult Indian males born in 1891-1957 and surveyed in the 1970s.

METHODS

Data are from Anthropological Surveys. Only men were included in the surveys due to high female illiteracy and lack of female researchers. Indian society was also strongly conservative at the time, especially in rural areas, and the measurement of women by men was not permitted. Heights and weights of 43 950 males 18-84 years (born 1891-1957) were measured. The BMI was calculated; weight status of individuals was classified relative to WHO criteria and suggested criteria for the Asia-Pacific region. Heights of men 35+ years were also adjusted for age-related stature loss. Trends in measured and adjusted heights, body weight and the BMI, and in weight status were evaluated by age groups. Linear regression of measured height and adjusted height on year of birth was used to estimate secular effects.

RESULTS

Mean heights declined slightly with age to 50 years and declined sharply through 60+ years, while mean weights increased into the 40s and then declined. Mean BMIs were relatively stable from 30 to 60 years. The prevalence of thinness and normal weight was high, while that of overweight and obesity was low. Regression analyses indicated limited secular change across the total range of birth years but suggested a decline in adjusted heights among men born in 1891 through the 1930s, and little change among men born subsequently.

CONCLUSIONS

Age-related trends and results of the regression analyses by year of birth indicated negligible secular change in heights of Indian men 18-84 years born between 1891 and 1957. BMIs indicated a high prevalence of thinness and normal weight and low prevalence of overweight and obesity.

Forensic age-at-death estimation using the sternal junction in Thai adults: an autopsy study

One of the main parameters in the analysis of skeletal remains in forensic anthropological cases is the estimation of age. This study aimed to investigate the correlation between age and the fusion status of the sternal junction. This crosssectional study was carried out on 184 sterna from 94 females and 90 males obtained from known-age cadavers in the Thai population. By direct observation, the fusion stage of the manubrio-sternal and sterno-xiphoidal junctions was studied and divided into unfused and fused joints. The results showed that a large proportion of the sterna remain unfused throughout adulthood, with fusion observed in both young and old cadavers. Insignificant differences in the rate of fusion, the sexes and ages were observed. None of the sterna under 30 years of age in females and 32 years of age in males showed fusion of the manubrio-sternal and sterno-xiphoidal junctions. Based on the variability of the sternal fusions observed in this study, we highlighted a very limited role of the sternum alone in the estimation of age in the Thai population.

Long-Term Health Associated with Small and Large for Gestational Age Births among Young Thai Adults

We examined the long-term health outcomes associated with being born small for gestational age (SGA) or large for gestational age (LGA). A total of 632 young adults aged ≈20.6 years were recruited from a longitudinal study (Chiang Mai, Thailand) in 2010: 473 born appropriate for gestational age (AGA), 142 SGA, and 17 LGA. The clinical assessments included anthropometry, blood pressure (BP), lipid profile, and an oral glucose tolerance test (OGTT). Young adults born SGA were 1.8 and 3.2 cm shorter than AGA (p = 0.0006) and LGA (p = 0.019) participants, respectively. The incidence of short stature was 8% among SGA compared with 3% in AGA and no cases among LGA participants, with the adjusted relative risk (aRR) of short stature among SGA 2.70 times higher than that of AGA counterparts (p = 0.013). SGA participants also had a 2 h glucose 7% higher than that of the AGA group (105 vs. 99 mg/dL; p = 0.006). Young adults born LGA had a BMI greater by 2.42 kg/m² (p = 0.025) and 2.11 kg/m² (p = 0.040) than those of SGA and AGA, respectively. Thus, the rate of overweight/obesity was 35% in the LGA group compared with 14.2% and 16.6% of SGA and AGA groups, respectively, with corresponding aRR of overweight/obesity of 2.95 (p = 0.011) and 2.50 (p = 0.017), respectively. LGA participants had markedly higher rates of BP abnormalities (prehypertension and/or hypertension) with an aRR of systolic BP abnormalities of 2.30 (p = 0.023) and 2.79 (p = 0.003) compared with SGA and AGA groups, respectively. Thai young adults born SGA had an increased risk of short stature and displayed some impairment in glucose metabolism. In contrast, those born LGA were at an increased risk of overweight/obesity and elevated blood pressure. The long-term follow-up of this cohort is important to ascertain whether these early abnormalities accentuate over time, leading to overt cardiometabolic conditions.

Secular trends in Javanese adult height: the roles of environment and educational attainment

Background

Since its independence in 1945, Indonesia has undergone rapid socioeconomic development. The fastest changes occurred in Java, which is the main island where more than half of the Indonesian population lives.

Objective

This study aimed to analyze the secular trend in the height of adults living in Java born between 1953 and 1995 by comparing their residence (rural, small city, or large city) and considering factors that contribute to adult height.

Methods

The analysis used the following data: birth year, body height, weight, body mass index, sex, educational attainment, share of household food expenditures, and residence of 20- to 40-year-old men and women collected by the Indonesia Family Life Survey (IFLS) waves 1 to 5. Multiple linear regression was conducted to analyze several factors that influence adult height. Significance was set at p < 0.05 with a 95% confidence interval (CI).

Results

The study included 30,656 measurements of individuals born between 1953 and 1995 (54.9% female). Positive secular trends (95% CI) were observed for men and women: 1.3 (1.1–1.4) cm and 0.9 (0.8–1.0) cm per decade, respectively. Multiple linear regression analyses showed that, in addition to the year of birth, the adult height of both males and females was independently associated with level of education and share of household food expenditure. Stratifying the data into residence in rural areas, small cities, and large cities showed that education levels influenced the adult height of men and women living in all regions, whereas the influence of birth year and share of household food expenditure differed between areas and genders.

Conclusions

We observed positive secular trends in the height of adults living in Java who were born between 1953 and 1995. The birth year, educational attainment, and share of household food expenditure significantly influenced adult height. A higher education level was consistently associated with taller adult height in both men and women living in rural areas, small cities, and large cities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13144-6.

Intergenerational change in anthropometry of children and adolescents in the New Delhi Birth Cohort

BACKGROUND

A comparison of the anthropometry of children and adolescents with that of their parents at the same age may provide a more precise measure of intergenerational changes in linear growth and body mass index (BMI).

METHODS

New Delhi Birth Cohort participants (F1), born between 1969 and 1972, were followed up for anthropometry at birth and at 6-monthly intervals until 21 years of age. At variable intervals 1447 children, aged 0-19 years (F2) and born to 818 F1 participants, were measured (weight and height), providing 2236 sets of anthropometries. Intergenerational changes (F2-F1) in height and BMI [absolute and standard deviation (SD) units] were computed by comparing children with their parents at corresponding ages.

RESULTS

F2 children were taller (P < 0.001) than their parents at corresponding ages; the increase {mean [95% confidence interval)CI)] World Health Organization SD units} was 0.97 (0.83, 1.11), 1.21 (1.10, 1.32), 1.09 (0.98, 1.19), 1.10 (1.00, 1.21) and 0.75 (0.65, 0.85) for age categories of 0-5, 5-7.5, 7.5-10, 10-12.5 and >12.5 years, respectively. In absolute terms, this increase ranged from 3.5 cm (0-5-year-olds) to 7.5 cm (10-12.5-year-olds). The corresponding increases in BMI SD scores were 0.32 (0.18, 0.47), 0.60 (0.45, 0.75), 1.13 (0.99, 1.27), 1.30 (1.15, 1.45) and 1.00 (0.85, 1.15), respectively. The absolute BMI increase ranged from 1-3 kg/m2 at >5 years age to ∼3 kg/m2 at >10-years of age. The intergenerational increases were comparable in both sexes, but were greater in children born and measured later. A positive change in socioeconomic status was associated with an increase in height across the generations.

CONCLUSIONS

Children and adolescents, throughout the ages 0-19 years, have become considerably taller and have a higher BMI than their parents at corresponding ages in an urban middle-class Indian population undergoing socioeconomic improvements.

Longitudinal growth patterns and final height in childhood-onset systemic lupus erythematosus

Patients with childhood-onset systemic lupus erythematosus (cSLE) are at risk of becoming short adults. To evaluate the growth patterns and risk factors of short final height, a retrospective study was conducted in 97 patients (87 females, 90%) with cSLE who grew from the time of diagnosis and reached their final height. The primary outcome was the final height. Participants were divided into participants with short final height (final height standard deviation score (HSDS) < - 2, n = 22, 23%) and participants with normal final height (final HSDS ≥ - 2, n = 75, 77%). At diagnosis, the mean age was 11.3 ± 2.4 years and HSDS was - 0.5 ± 1.3. The participants reached the final height of 1.51 ± 0.08 m (final HSDS - 1.3 ± 0.1) at mean age of 16.2 ± 2.3 years. The HSDS of participants with short final height steadily declined throughout the course of SLE (p = 0.02), and were significantly lower than participants with normal final height at any time point (p < 0.001). In participants with normal final height, HSDS significantly declined from baseline until 2 years after diagnosis (p = 0.01), and then became stable thereafter. The independent risk factors for short final height were the male sex, short stature at diagnosis, low body weight at final height, and cumulative corticosteroid dose.Conclusion: A substantial number of the participants with cSLE became short adults. Adequate nutrition and corticosteroid minimization should be emphasized in patients at high risk for short final height. What is known? • Growth failure is common in SLE due to many risk factors including chronic inflammation, malnutrition, and long-term use of corticosteroids. • In comparison to growth failure, final height is a better indicator of growth as the prevalence of growth failure is variable depending on definitions, patient age and pubertal status. What is new? • Nearly one fourth of children with SLE have short final height. • The independent risk factors for short final height were the male sex, short stature at diagnosis, low body weight at final height, and cumulative corticosteroid dose.

Cost-effectiveness of insulin detemir versus insulin glargine for Thai type 2 diabetes from a payer's perspective

AIMS

An economic evidence is a vital tool that can inform the decision to use costly insulin analogs. This study aimed to evaluate long-term cost-effectiveness of insulin detemir (IDet) compared with insulin glargine (IGlar) in type 2 diabetes (T2DM) from the Thai payer's perspective.

METHODS

Long-term costs and outcomes were projected using a validated IMS CORE Diabetes Model, version 8.5. Cohort characteristics, baseline risk factors, and costs of diabetes complications were derived from Thai data sources. Relative risk was derived from a systematic review and meta-analysis study. Costs and outcomes were discounted at 3% per annum. Incremental cost-effectiveness ratio (ICER) was presented in 2015 US Dollars (USD). A series of one-way and probabilistic sensitivity analyses were performed.

RESULTS

IDet yielded slightly greater quality-adjusted life years (QALYs) (8.921 vs 8.908), but incurred higher costs than IGlar (90,417.63 USD vs 66,674.03 USD), resulting in an ICER of ∼1.7 million USD per QALY. The findings were very sensitive to the cost of IDet. With a 34% reduction in the IDet cost, treatment with IDet would become cost-effective according to the Thai threshold of 4,434.59 USD per QALY.

CONCLUSIONS

Treatment with IDet in patients with T2DM who had uncontrolled blood glucose with oral anti-diabetic agents was not a cost-effective strategy compared with IGlar treatment in the Thai context. These findings could be generalized to other countries with a similar socioeconomics level and healthcare systems.

Can resource dilution explain differences in height by birth order and family size? A study of 389,287 male recruits in twentieth-century Netherlands

'Resource dilution' has been invoked as a possible mechanism to explain the inverse relation between sibship size and sibling heights in European populations (Öberg, 2015). Alternative explanations include confounding of the relation by other measured or unmeasured family characteristics including socio-economic position or birth order. It is difficult to quantify the contribution of any factor in isolation. To examine the question, we accessed data from the national birth cohort of 389,287 Dutch conscripts born in 1944-1947 and examined for military service at age 18. The records include all men of Dutch nationality born between January 1, 1944 and December 31, 1947 examined for military service in the Netherlands. The birth cohorts provide a well-defined study population to reliably assess the impact of family size and birth order on adult height, accounting for potential confounders. The cohorts include a large number of high-parity families, provide reliable information on both family size and birth order, and differentiate between all birth orders. The military examinations provide reliable information on height for all study subjects and uniform measurements at age 18. We show that recruits from larger families are shorter than recruits from smaller families; that birth order effects are small in relation to family size effects; and that birth order and family size effects are comparable in recruits from higher to lower socio-economic backgrounds. Recruits from higher backgrounds are significantly taller however. Our findings are compatible with a 'resource dilution' hypothesis, but our data provide no information on any specific differences in the childhood environment in terms of nutrition, education, or other family behaviours could explain the observed height differences at age 18. Additional studies will be needed to identify what differences in specific family behaviours could lead to changes in height development.

Clinical and genetic characterization of pituitary gigantism: an international collaborative study in 208 patients

Despite being a classical growth disorder, pituitary gigantism has not been studied previously in a standardized way. We performed a retrospective, multicenter, international study to characterize a large series of pituitary gigantism patients. We included 208 patients (163 males; 78.4%) with growth hormone excess and a current/previous abnormal growth velocity for age or final height >2 s.d. above country normal means. The median onset of rapid growth was 13 years and occurred significantly earlier in females than in males; pituitary adenomas were diagnosed earlier in females than males (15.8 vs 21.5 years respectively). Adenomas were ≥10 mm (i.e., macroadenomas) in 84%, of which extrasellar extension occurred in 77% and invasion in 54%. GH/IGF1 control was achieved in 39% during long-term follow-up. Final height was greater in younger onset patients, with larger tumors and higher GH levels. Later disease control was associated with a greater difference from mid-parental height (r=0.23, P=0.02). AIP mutations occurred in 29%; microduplication at Xq26.3 - X-linked acrogigantism (X-LAG) - occurred in two familial isolated pituitary adenoma kindreds and in ten sporadic patients. Tumor size was not different in X-LAG, AIP mutated and genetically negative patient groups. AIP-mutated and X-LAG patients were significantly younger at onset and diagnosis, but disease control was worse in genetically negative cases. Pituitary gigantism patients are characterized by male predominance and large tumors that are difficult to control. Treatment delay increases final height and symptom burden. AIP mutations and X-LAG explain many cases, but no genetic etiology is seen in >50% of cases.

Differences in height by education among 371,105 Dutch military conscripts

Adult height is associated with a variety of familial and socio-economic factors and large, well-defined populations are needed for a reliable assessment of their relative contributions. We therefore analyzed recorded heights from the military health examinations of 18-year conscripts in the Netherlands born between 1944 and 1947 and observed large differences by their attained education and by their father's occupation. The 5.1 cm height gradient from lowest to highest education level was more than twice as large as the gradient between father's occupation levels. The education gradient was not explained by common determinants of height including paternal occupation as a measure of familial background, region of birth, family size, or religion.

Secular trends in body height and body mass in 19-year-old Polish men based on six national surveys from 1965 to 2010

OBJECTIVES

The aim was to determine whether an intergenerational trend toward increased stature is slowing down, and whether body weight has recently increased among young men in Poland, as it has in Western European countries.

METHODS

Data were taken from six national surveys of 19-year-old Polish male conscripts from cohorts 1965, 1976, 1986, 1995, 2001, and 2010.

RESULTS

The mean stature of this population increased throughout the last 45 years from 170.5 cm in 1965 to 178.3 in 2010. However, the average gain in stature per decade declined from 2.4 cm in the period 1965 to 1976 to 0.8 cm per decade in 1995 to 2001, but increased to 1.0 cm in the last period. The average of body weight increased from 63.2 kg in 1965 to 73.1 in 2010 and body mass index (BMI) rose from 21.73 to 22.94 in the same period. The tempo of increase varied in different periods; between 1965 and 1986 an insignificant increase was observed (of circa 0.12); in 1986 to 1995 there was no increase, whereas the period of 2001 to 2010 witnessed a significant increase (of circa 0.76).

CONCLUSIONS

The trend of body size and stature increase within the Polish population, although decelerating, remained positive and steady during the last 45 years. No significant impact of the past half-century's socioeconomic crises was observed in these measures of growth. We concluded that during the economic crises some effective mechanism protecting the living conditions of the children and youth were operating within the population.

Sugar sweetened beverages and weight gain over 4 years in a Thai national cohort--a prospective analysis

INTRODUCTION

Sugar sweetened beverages (SSBs) are implicated in the rising prevalence of obesity and diet-related chronic diseases worldwide. However, little is known about their contribution to weight gain in Asian populations. This study aimed to investigate weight change associated with SSB consumption between 2005 and 2009 in a large national cohort of Thai university students.

METHODS

Questionnaire data were collected from a large Thai cohort (the Thai Health-Risk Transition: a National Cohort Study). The analysis was based on responses from 59 283 of the 60 569 (98%) cohort members who had valid SSB consumption and weight variables in 2005 and 2009. The relationship between SSB consumption in 2005 and self-reported weight change was analysed using multiple linear regression models controlled for socio-demographic, activity and (non-validated) dietary factors shown to influence weight.

RESULTS

Higher frequency of SSB consumption in 2005 was significantly associated with greater weight gain between 2005 and 2009 in all age groups and in both sexes (p<0.0001); persons who consumed SSBs at least once a day in 2005 gained 0.5 kg more than those who consumed SSBs less than once a month. The estimated weight gain for the average person in the sample was 1.9 kg (95% C I 1.95-1.96). The difference in weight gain between those who increased their consumption frequency (<once a month to > once per day) between 2005 and 2009 compared to those who maintained it was 0.3 kgs, while persons who reduced their consumption frequency (once a day to > once a month) gained 0.2 kgs less than those whose consumption remained unchanged.

CONCLUSION

SSB consumption is independently associated with weight gain in the Thai population. Research and health promotion in Thailand and other economically transitioning countries should focus on reducing their contribution to population weight gain and to diet-related chronic diseases.

Inequalities in Risks and Outcomes in a Health Transitioning Country: A Review of a Large National Cohort of Thai Adults

This article reviews inequalities in health risks and outcomes based on a large longitudinal cohort study of distance-learning adult students enrolled at Sukhothai Thammathirat Open University (n = 87,134). The study began in 2005 and the first follow-up was completed in 2009. Risks analyzed for health inequalities were divided into demographic, socioeconomic, geographical, behavioral, and environmental groups. Unequal risks and outcomes identified that would be amenable to policy interventions in transitional Thailand include the following: heat stress-contributing to many adverse outcomes, including occupational injury, psychological distress, and kidney disease; urbanization-unhealthy eating, sedentary lifestyles, low social capital, and poor mental health; obesity-increasingly common especially with rising income and age among men; and injury-big problem for young males and associated with excessive alcohol and dangerous transport. These substantial inequalities require attention from multisectoral policy makers to reduce the gaps and improve health of the Thai population.

Nutrition transition, food retailing and health equity in Thailand

AIM: Here we examine the influence of changes in food retailing, the food supply and the associated nutrition transition on health equity in Thailand, a middle income country experiencing rapid economic development. METHODS: The dietary transition underway in Thailand is reviewed along with theories regarding convergence to a globalised energy dense obesogenic diet and subsequent socio-economically related dietary divergence along with the implications for health inequity. RESULTS: Thailand is part way through a dietary, nutrition and health transition. The food distribution and retailing system is now 50% controlled by modern supermarkets and convenience stores. The problem of increasing availability of calorie dense foods is especially threatening because a substantial proportion of the adult population is short statured due to child malnutrition. Obesity is an emerging problem and for educated Thai women has already developed an inverse relationship to socio-economic status as found in high income countries. CONCLUSIONS: Thailand has reached an important point in its nutrition transition. The challenge for the Thai government and population is to boost affordable healthy diets and to avoid the socio-economic inequity of nutritional outcomes observed in many rich countries.