Decreased external skeletal robustness in schoolchildren--a global trend? Ten year comparison of Russian and German data

Comparison of frame index reference percentiles in Argentine and European boys and girls

INTRODUCTION

The frame index (FI), based on measurements of elbow breadth and height, is the body frame size parameter most frequently used in child and adolescent populations to assess skeletal robustness. In 2018, the first FI reference percentiles were elaborated with data of boys and girls aged 0-18 years from different European populations. In Argentina, the FI reference values were published in 2022.

OBJECTIVE

The present study aims to compare the Argentine (AR) and European (EU) FI reference percentiles to evaluate possible variation in bone robustness between populations.

METHODS

The values of the 3rd, 50th and 97th percentiles of the AR and EU FI references for boys and girls aged 4-14 years were compared using the Wilcoxon test (p < .05). Percentage differences between means (PDM) were calculated to analyze the magnitude of the differences between both references. The R 3.2.0 program was used to plot the percentile curves.

RESULTS

The FI reference values were lower in AR than in EU in both the 3rd and the 50th percentiles, regardless of sex and age. Conversely, the AR reference values of the 97th percentile were higher than the EU values at most ages.

CONCLUSIONS

The comparison of the AR and EU FI references showed similar age and sex growth patterns. However, differences in percentile values between populations were observed, highlighting the importance of having local references for the evaluation of skeletal robustness.

Anthropometric parameters to estimate body frame size in children and adolescents: A systematic review

OBJECTIVE

To determine the most frequently body frame size (BFS) measurement and to compare the cut-off values used for classifying body size in children and adolescents.

METHODS

This systematic review focused on primary studies and scientific reports published in Medline Ovid, EMBASE, Web of Science, or Scopus between January 1, 2007 and March 31, 2021. Eligible studies must have included at least one BFS parameter measured in healthy children or adolescents. A descriptive analysis and graphic comparison were performed when values of the body frame were available.

RESULTS

A total of 26 studies involving 317 202 children and adolescents from all over the world were included. The report of Frame index predominated (46%). It was followed by the biacromial diameter single or combined with the bitrochanteric and biiliocristal diameter (27%), the wrist circumference (19%), and the grant index (12%). Fourteen studies reported percentile values of the BFS measurement, but only four presented cut-off values.

CONCLUSIONS

There was no unified BFS measurement in children and adolescents neither reference cut-off values for categorization. The Frame index was the most frequently used. It is difficult to compare BFS statistics due to the diversity of measurements. It is necessary to standardize the use of the methods for measuring BFS.

Testing the cross-applicability of juvenile sex estimation from diaphyseal dimensions

Sex estimation is a crucial component of the biological profile. Stull et al. (2017) have proposed a promising juvenile sex estimation method using long bone measurements taken from a South African sample, providing relatively high classification accuracies and made easy to use via the KidStats web-based app. In this study, we test the models developed by Stull et al. (2017) on an external historic population from Lisbon, Portugal, in order to determine whether the models can be reliably applied to archeological and forensic populations outside of the original population sample. The study sample consisted of 102 individuals (45 females and 57 males) aged under 13 years at death from the Lisbon identified skeletal collection. Measurements from these individuals were used to test the flexible discriminant analysis (FDA) models given by Stull et al. (2017). Allocation accuracies were calculated for boys and girls and children over and under 2 years separately and combined. Our findings show that the models developed by Stull et al. (2017) yield poor accuracy when applied to our external population and thus can potentially be misapplied on archeological skeletal remains or forensic remains of unknown origin. A number of statistical issues may explain why models fail to be transportable or even generalizable, namely multicollinearity, model overfitting and overly optimist bootstrapped cross-validation rates. It is also likely that population differences in size and sexual size dimorphism also affected the applicability of the models. We emphasize the importance of externally validating prediction models, particularly if they are intended to be applied across populations. Our study addresses Stull and co-worker's request for further validation of the method on populations outside of South Africa, as the models cannot be confidently applied in the field until it has been externally validated.

Stunting as a Synonym of Social Disadvantage and Poor Parental Education

Socially, economically, politically and emotionally (SEPE) disadvantaged children are shorter than children from affluent background. In view of previous work on the lack of association between nutrition and child growth, we performed a study in urban schoolchildren. We measured 723 children (5.83 to 13.83 years); Kupang, Indonesia; three schools with different social background. We investigated anthropometric data, clinical signs of malnutrition, physical fitness, parental education, and household equipment. Subjective self-confidence was assessed by the MacArthur test. The prevalence of stunting was between 8.5% and 46.8%. Clinical signs of under- or malnutrition were absent even in the most underprivileged children. There was no delay in tooth eruption. Underprivileged children are physically fitter than the wealthy. The correlation between height and state of nutrition (BMI_SDS, skinfold_SDS, MUAC_SDS) ranged between r = 0.69 (p < 0.01) and r = 0.43 (p < 0.01) in private school children, and between r = 0.07 (ns) and r = 0.32 (p < 0.01) in the underprivileged children. Maternal education interacted with height in affluent (r = 0.20, p < 0.01) and in underprivileged children (r = 0.20, p < 0.01). The shortness of SEPE disadvantaged children was not associated with anthropometric and clinical signs of malnutrition, nor with delay in physical development. Stunting is a complex phenomenon and may be considered a synonym of social disadvantage and poor parental education.

Secular Changes in Body Build and Body Composition in Czech Preschool Children in the Context of Latent Obesity

Changes in lifestyle can be significantly reflected in growth and development. Adaptations to reduced levels of physical activity, together with non-corresponding nutritional intakes, can result in body build and body composition changes at an early age. The present cross-sectional study aimed to evaluate the secular trend of modifications of body composition and body mass index (BMI) in Czech preschoolers over the last two to three decades. Boys and girls (386 boys and 372 girls) aged 4 to 6 years in 2014–2019 were measured. Outcome data were compared with the reference sample of preschoolers from 1990: 911 boys and 896 girls. Body height, BMI, and percentage of body fat, muscle, and bone mass were evaluated. Height and BMI have not changed. Body fat increased in both genders (p < 0.01), and contrarily, a significant reduction of muscle and skeletal mass was revealed (p < 0.001). Significant changes in body composition and unchanged BMI indicate the development of latent obesity during the last few decades. Due to latent obesity in a recent cohort, the differences in the prevalence of overweight and obesity markers according to BMI and fat percentage were tested. The prevalence of overweight and obesity was higher by 7.2% in boys, and by 6.5% in girls, as compared to children evaluated according to only their BMI results. Secular changes in preschoolers’ physical builds over the last 25 years are not reflected in body height and BMI, but in body composition. Insufficient development of active, lean body mass proportionally compensated by increased fat mass was also indicated.

External skeletal robustness and adiposity in adolescents of low socioeconomic status: A cross-sectional analysis of body composition

OBJECTIVES

External skeletal robustness has been decreasing in children, potentially due to a lack of physical activity and the increased prevalence of obesity. However, whether socioeconomic status (SES) influences external skeletal robustness in adolescents has not yet been examined.

METHODS

A cross-sectional study was performed to examine 370 Chilean adolescents (16.15 ± 1.01 years old) recruited from distinct educational establishments. Body fat percentage (BF%) was evaluated using Ellis' equations for Hispanic children. Obesity was defined as ≥25 BF% in males and ≥ 30 BF% in females. External skeletal robustness was obtained by measuring the humerus biepicondylar width and height (Frame-Index). SES was obtained through the ESOMAR survey.

RESULTS

Females exhibited significantly greater BF% and lower Frame-Index values than males (P < .001). Obese adolescents (by BF%) had greater Frame-Index values than non-obese adolescents (P < .001). Females of medium-high SES had significantly lower BF% and Frame-Index values than females of medium and medium-low SES. BF% had a positive correlation with Frame-Index values in all SES groups studied, except in males of medium-high SES. As SES decreased, the correlation increased in both sexes, but overall, the correlation was greater in females than males.

CONCLUSIONS

The results of this investigation suggest that obesity increases external skeletal robustness in adolescents. Additionally, lower SES corresponded to higher BF% and Frame-Index values. Therefore, modern conditions that influence the prevalence of obesity in adolescence could be affecting bone health in adolescents, primarily in females of medium-low SES.

Body frame size, body image, self-esteem, and health-related quality of life in schoolchildren

OBJECTIVE

The aim of this study was to explore the relationship between body frame size (BFS) and body image, self-esteem, and health-related quality of life (HRQL) in Mexican schoolchildren.

METHODS

This cross-sectional study included children aged 6 to 11 years. Body image, self-esteem, and HRQL were evaluated through interviews. Two frame-size measures, biacromial and bitrochanteric diameters, were collected and summed for categorizing BFS as small, medium, or large. Height and weight were also measured. Spearman's correlations were determined and adjusted by sex, age, and body mass index (BMI). Multiple logistic regression analyses were performed with the psychological measure as the binary dependent variable, the categories of BFS as the independent variable, and sex, age, and BMI as control variables.

RESULTS

The correlation between BFS and body image was 0.15 (P < .01) and after BMI adjustment was 0.07 (P > .05). BFS did not correlate with self-esteem nor HRQL (P > .05). Of the children, 79% were dissatisfied with their body image, 20% had a low self-esteem, and 31.8% had a poorly perceived HRQL; there were no differences by BFS. The multivariate analysis showed that a large BFS was not associated with body image dissatisfaction (OR 1.2, 95% CI 0.6-2.3), low self-esteem (OR 1.3, 95% CI 0.7-2.6), or poor HRQL (OR 1.3, 95% CI 0.8-2.2).

CONCLUSIONS

BFS was not correlated with body image, self-esteem, or HRQL. A high self-esteem and a good level of HRQL prevailed, but a high proportion of children were dissatisfied with their body image. School interventions should promote an appropriate body image and a healthy lifestyle.

Poor Skeletal Robustness on Lower Extremities and Weak Lean Mass Development on Upper Arm and Calf: Normal Weight Obesity in Middle-School-Aged Children (9 to 12)

Background: Normal weight obesity in children has been associated with excessive body fat, lower bone density and decreased total lean mass. However, no studies have been done into whether normal weight obese children differ in skeletal robustness or lean mass development on the extremities from normal weight non-obese, overweight, and obese peers although these are important indicators of healthy development of children. Methods: Body height, body weight, BMI, four skinfolds, and two limb circumferences were assessed. We calculated total body fat using Slaughter's equations, the Frame index for skeletal robustness and muscle area for the upper arm and calf using Rolland-Cachera equations. Using national references of BMI and measured skinfolds, three subgroups of participants (9-12 years) consisting of 210 middle-school-aged children (M-age = 11.01 ± 1.05)-110 girls and 100 boys-were selected: (A) overweight obese (OWOB) (n = 72); (B) normal weight obese (NWO) (n = 69); and, (C) normal weight non-obese (NWNO) (n = 69). All values, were converted to Z-scores to take account of participant's sex and age. Results: NWO children had significantly poorer skeletal robustness on lower extremities and poorer muscle area on the upper arm and calf compared to NWNO counterparts with significantly higher evidence in boys-skeletal robustness NWO boys: Z-score = -0.85; NWO girls: Z-score = -0.43; lean mass on the calf: NWO boys Z-score = -1.34; NWO girls: Z-score = -0.85. The highest skeletal robustness-but not muscle area on the calf-was detected in OWOB children. Conclusions: Further research should focus on whether this poor skeletal and lean mass development: (1) is a consequence of insufficient physical activity regimes; (2) affects physical fitness of NWO children and could contribute to a higher prevalence of health problems in them. We have highlighted the importance of the development of a simple identification of NWO children to be used by pediatricians.

Height and skeletal morphology in relation to modern life style

Height and skeletal morphology strongly relate to life style. Parallel to the decrease in physical activity and locomotion, modern people are slimmer in skeletal proportions. In German children and adolescents, elbow breadth and particularly relative pelvic breadth (50th centile of bicristal distance divided by body height) have significantly decreased in recent years. Even more evident than the changes in pelvic morphology are the rapid changes in body height in most modern countries since the end-19th and particularly since the mid-20th century. Modern Japanese mature earlier; the age at take-off (ATO, the age at which the adolescent growth spurt starts) decreases, and they are taller at all ages. Preece-Baines modelling of six national samples of Japanese children and adolescents, surveyed between 1955 and 2000, shows that this gain in height is largely an adolescent trend, whereas height at take-off (HTO) increased by less than 3 cm since 1955; adolescent growth (height gain between ATO and adult age) increased by 6 cm. The effect of globalization on the modern post-war Japanese society (“community effect in height”) on adolescent growth is discussed.

Decline in objective physical activity over a 10-year period in a Japanese elementary school

Background

The purpose of this study was to examine the change in accelerometer-derived daily physical activity (PA) and activity record-derived daily activities over a 10-year period in urban elementary schoolchildren in Japan.

Methods

A total of 233 sixth-grade children (11–12 years old) in a same elementary school in Kyoto participated in the study (n = 125 and 108 in 1999 and 2009, respectively). The participant rate is 91.9 and 98.2 % in 1999 and 2009, respectively. The size and shape of the school district was not changed. The children were instructed to wear an accelerometer for 5 consecutive days of weekday and to keep minute-by-minute 24-h activity records with the assistance of their parents. The school-day scheduling was similar between 1999 and 2009 (29 and 27 sessions of 45-min class per week, respectively).

Results

From 1999 to 2009, step counts considerably decreased (20,832 vs. 12,237 steps per day in boys and 16,087 vs. 10,748 steps per day in girls; P < 0.001) with concomitant significant decreases in total energy expenditure (P = 0.011), activity energy expenditure (P < 0.001), and physical activity level (P < 0.001). Time spent playing outdoors and walking to school were also significantly less in 2009 than 1999 (P < 0.001). Accelerometer-measured PA was significantly associated with the amount of time spent playing outdoors and walking to school.

Conclusions

These results indicate that elementary schoolchildren in 2009 spend less time playing outdoors and walking to school, perform less PA, and take fewer steps than children of a decade ago.

Is there an influence of modern life style on skeletal build?

OBJECTIVES

Modern human life style has led to significant decrease in everyday physical activity and bipedal locomotion. It has previously been shown that skeletal robustness (relative elbow breadth) is associated with daily step counts. The aim of the study was to investigate whether also other skeletal measures, particularly pelvic breadth may have changed in recent decades.

METHODS

We re-analyzed elbow breadth, pelvic breadth (bicristal), and thoracic depth and breadth, of up to 28,975 healthy females and 28,288 healthy males aged 3-18 years from cross-sectional anthropological surveys performed between 1980 and 2012 by the Universities of Potsdam and Berlin, Germany.

RESULTS

Relative elbow breadth (Frame index) significantly decreased in both sexes since 1980 (<0.001). The trend toward slighter built was even more pronounced in absolute and relative pelvic breadth. In contrast, equivalent changes of parts of the skeletal system that are not involved in bipedal locomotion such as thoracic breadth, thoracic depth, and the thoracic index were absent.

CONCLUSIONS

The present investigation confirms the decline in relative elbow breadth in recent decades. Analogue, but even more pronounced changes were detected in pelvic breadth that coincides with the modern decline in upright locomotion. The findings underscore the phenotypic plasticity of humans while adapting to new environmental conditions.