Secular Trends in Human Skeletal Growth: Stature Change and Appositional Bone Development in a 19th and Early 20th Century Finnish Skeletal Population

This thesis aims to examine secular changes in four skeletal growth parameters (recorded living stature, bone length, total cross-sectional area (TA) and twice average bending rigidity ‘J’ in femur, tibia and humerus) using adult male individuals from a 19th and early 20th century Finnish skeletal collection. Further objectives are to investigate whether the study individuals’ prisoner status introduces variation in the skeletal parameters within the sample as well as to examine what environmental indicators may have a relationship with the examined parameters. Data on bone cross-sectional geometric properties (CSG) were collected using a desktop 3D laser scanner whilst environmental data were acquired using existing Finnish data sources. The results showed a significant secular increase in stature, which was also reflected in femur length. Humeral (CSG) properties showed a significant secular decrease. Individuals who were prisoners had significantly smaller TA and lesser J at 35% length of the humerus than non-prisoners. It is concluded that the changing living conditions of late 19th and early 20th century Finland seem to have affected both endochondral and appositional bone growth of this sample, whereby improvements in the country’s disease and nutritional environment after the Finnish Famine could explain the found secular trend in stature and femur length. Changes in childhood loading history after the introduction of free elementary school in Finland are a possible explanation for the secular decrease in the humerus cross- sectional geometric properties, and might also be related to the found difference between prisoners and non-prisoners

Growth, socioeconomic position and later life outcomes in Guatemala, 1953–2017

It is well-established that early life environmental exposures and later life health and non-communicable disease (NCD) risk are related, however, life course evidence from low- and middle-income countries is currently limited. Guatemala, a middle-income country located in Central America, is both one of the most income inequal and most stunted countries in the world. It is also the site of the Universidad del Valle de Guatemala (UVG) Longitudinal Study of Child and Adolescent Development. The study followed the growth of over 40,000 urban school children of different socioeconomic position (SEP) groups between 1953-1999. Previous research, on subsamples of the study, has identified socioeconomic inequalities in both physical growth and cognitive ability but the later life health of UVG Study individuals is unknown, as are the broader patterns of growth and development of the entire sample. [Continues.]</div

Inequalities in adiposity trends between 1979 and 1999 in Guatemalan children

BACKGROUND: Guatemala suffered from civil war and high levels of inequality and childhood stunting in the second half of the 20th century, but little is known about inequalities in secular trends in adiposity. OBJECTIVES: To investigate differences in childhood body mass index (BMI) and skinfold thickness trajectories from 1979 to 1999 between three groups of children: High socioeconomic position (SEP) Ladino, Low SEP Ladino, and Low SEP Indigenous Maya. METHODS: The sample comprised 19 346 children aged 7-17 years with 54 638 observations. The outcomes were height, BMI, triceps skinfold thickness (TST), and subscapular skinfold thickness (SST) Z-scores according to the Centers for Disease Control and Prevention (CDC) references. Sex-specific multilevel models were used to estimate and compare mean trajectories from 1979 to 1999 between the three groups. RESULTS: Mean Z-scores were always highest for High SEP Ladino children and lowest for Low SEP Maya children. Despite their very short stature, the Low SEP groups had SST trajectories that were above the 50th centile. The BMI trajectories were relatively flat and within one major centile band of the CDC median, with differences between the three groups that were small (0.2-0.3 Z-scores) and did not attenuate over time. Conversely, the TST Z-score trajectories demonstrated larger positive secular trends (e.g., from -1.25 in 1979 to -0.06 in 1999 for Low SEP Maya boys), with differences between the three groups that were large (0.5-1.2 Z-scores) and did attenuate over time (in boys). Secular trends and between-group difference in the SST Z-score trajectories were less pronounced, but again we found stronger evidence in boys that the estimated inequalities attenuated over time. CONCLUSIONS: Secular trends and inequalities in skinfolds differ from those for BMI in Guatemalan children. Differences between groups in skinfolds attenuated over time, at least in boys, but whether this is good news is questionable given the very short stature yet relatively large subscapular skinfolds of the Low SEP groups

Effects of stunting on body composition, biological age, and muscle strength of Maya and Ladino children in Guatemala [Abstract]

Effects of stunting on body composition, biological age, and muscle strength of Maya and Ladino children in Guatemala [Abstract

Life course associations of height, weight, fatness, grip strength, and all-cause mortality for high socioeconomic status Guatemalans

Objectives: The objective of this study was to investigate the association between physical growth in pre-adult life with five outcomes at age 64-76: weight, body mass index, estimated body fat percentage, hand grip strength and mortality. Methods: Super-Imposition by Translation and Rotation (SITAR) growth curves of 40,484 Guatemalan individuals aged 3-19 years were modelled for the parameters of size, timing and intensity (peak growth velocity, e.g. cm/year) of height, weight, body mass index, and grip strength. Associations between the SITAR parameters and old age outcomes were tested using linear and binary logistic regression for a follow-up sample of high socioeconomic status (SES) Guatemalans, of whom 50 were aged 64-76 years old at re-measurement and 45 died prior to the year 2017. Results: SITAR models explained 69-98% of the variance in each outcome, with height the most precise. Individuals in the follow-up sample who had a higher BMI before age 20 years had higher estimated body fat (B=1.4 CI -0.02-2.8) and BMI (B=1.2, CI 0.2-2.2) at the ages 64-76 years. Those who grew slower in height but faster in weight and BMI before age 20 years, had higher BMI and body fat later in life. Conclusions: These findings highlight the importance of a life course perspective on health and mortality risk. Childhood exposures leading to variation in pre-adult growth may be key to better understanding health and mortality risks in old age

Four decades of socioeconomic inequalities and secular changes in the physical growth of Guatemalans [abstract]

Four decades of socioeconomic inequalities and secular changes in the physical growth of Guatemalans [abstract

Four decades of socio-economic inequality and secular change in the physical growth of Guatemalans

OBJECTIVE: To investigate changes in socio-economic inequalities in growth in height, weight, BMI and grip strength in children born during 1955-1993 in Guatemala, a period of marked socio-economic-political change. DESIGN: We modelled longitudinal data on height, weight, BMI and hand grip strength using Super-Imposition by Translation and Rotation (SITAR). Internal Z-scores summarising growth size, timing and intensity (peak growth velocity, e.g. cm/year) were created to investigate inequalities by socio-economic position (SEP; measured by school attended). Interactions of SEP with date of birth were investigated to capture secular changes in inequalities. SETTING: Urban and peri-urban schools in the region of Guatemala City, Guatemala. PARTICIPANTS: Participants were 40 484 children and adolescents aged 3-19 years of Ladino and Maya ancestry (nobservations 157 067). RESULTS: The difference in height (SITAR size) between lowest and highest SEP decreased from -2·0 (95 % CI -2·2, -1·9) sd to -1·4 (95 % CI -1·5, -1·3) sd in males, and from -2·0 (95 % CI -2·1, -1·9) sd to -1·2 (95 % CI -1·3, -1·2) sd in females over the study period. Inequalities also reduced for weight, BMI and grip strength, due to greater secular increases in lowest-SEP groups. The puberty period was earlier and shorter in higher-SEP individuals (earlier SITAR timing and higher SITAR intensity). All SEP groups showed increases in BMI intensity over time. CONCLUSIONS: Inequality narrowed between the 1960s and 1990s. The lowest-SEP groups were still >1 sd shorter than the highest. Risks remain for reduced human capital and poorer population health for urban Guatemalans

Early childhood weight gain: Latent patterns and body composition outcomes.

BACKGROUND: Despite early childhood weight gain being a key indicator of obesity risk, we do not have a good understanding of the different patterns that exist. OBJECTIVES: To identify and characterise distinct groups of children displaying similar early-life weight trajectories. METHODS: A growth mixture model captured heterogeneity in weight trajectories between 0 and 60 months in 1390 children in the Avon Longitudinal Study of Parents and Children. Differences between the classes in characteristics and body size/composition at 9 years were investigated. RESULTS: The best model had five classes. The "Normal" (45%) and "Normal after initial catch-down" (24%) classes were close to the 50th centile of a growth standard between 24 and 60 months. The "High-decreasing" (21%) and "Stable-high" (7%) classes peaked at the ~91st centile at 12-18 months, but while the former declined to the ~75th centile and comprised constitutionally big children, the latter did not. The "Rapidly increasing" (3%) class gained weight from below the 50th centile at 4 months to above the 91st centile at 60 months. By 9 years, their mean body mass index (BMI) placed them at the 98th centile. This class was characterised by the highest maternal BMI; highest parity; highest levels of gestational hypertension and diabetes; and the lowest socio-economic position. At 9 years, the "Rapidly increasing" class was estimated to have 68.2% (95% confidence interval [CI] 48.3, 88.1) more fat mass than the "Normal" class, but only 14.0% (95% CI 9.1, 18.9) more lean mass. CONCLUSIONS: Criteria used in growth monitoring practice are unlikely to consistently distinguish between the different patterns of weight gain reported here

Development of Public Health Core Outcome Sets for Systems-Wide Promotion of Early Life Health and Wellbeing

We aimed to develop a core outcome set (COS) for systems-wide public health interventions seeking to promote early life health and wellbeing. Research was embedded within the existing systems-based intervention research programme ‘ActEarly’, located in two different areas with high rates of child poverty, Bradford (West Yorkshire) and the Borough of Tower Hamlets (London). 168 potential outcomes were derived from five local government outcome frameworks, a community-led survey and an ActEarly consortium workshop. Two rounds of a Delphi study (Round 1: 37 participants; Round 2: 56 participants) reduced the number of outcomes to 64. 199 members of the community then took part in consultations across ActEarly sites, resulting in a final COS for systems-based public health interventions of 40 outcomes. These were grouped into the domains of: Development & education (N = 6); Physical health & health behaviors (N = 6); Mental health (N = 5); Social environment (N = 4); Physical environment (N = 7); and Poverty & inequality (N = 7). This process has led to a COS with outcomes prioritized from the perspectives of local communities. It provides the means to increase standardization and guide the selection of outcome measures for systems-based evaluation of public health programmes and supports evaluation of individual interventions within system change approaches

Distinct Body Mass Index Trajectories to Young-Adulthood Obesity and Their Different Cardiometabolic Consequences.

[Figure: see text]