Frank Falkner

Sexual maturation and obesity in 9- and 10-year-old black and white girls: The National Heart, Lung, and Blood Institute Growth and Health Study

OBJECTIVE To assess the relationship between pubertal maturation and obesity in 9- and 10-year-old black and white girls. METHOD Cross-sectional analysis of cohort baseline data. SUBJECTS A cohort of 2379 girls recruited from selected schools in Richmond, Calif., and greater Cincinnati, Ohio, and from the membership rolls of a prepaid group practice in greater Washington, D.C. RESULTS Sixty-four percent of black girls had begun pubertal maturation compared with 33% of white girls. In prepubertal girls, racial differences in height, weight, body mass index (kilograms per square meter) and skin-fold thickness were not significant. Within each race, onset of pubertal maturation was associated with greater height, weight, body mass index, and skin-fold measurements. Within 9-year-old girls who had begun pubertal maturation but not reached menarche, black girls were taller and heavier than white girls. Among pubertal but premenarcheal 10-year-old subjects, black girls were taller and heavier and had greater body mass index and subscapular skin-fold values. After analyses were adjusted for pubertal maturation stage by means of pubic hair development, 10-year-old pubertal black girls remained taller and heavier, but racial differences in body mass index and the sum of skin-fold measurements ceased to be significant. CONCLUSIONS These findings suggest that the initiation of racial differences in obesity are related, at least temporally, to pubertal maturation.

Indexes of obesity and comparisons with previous national survey data in 9- and 10-year-old black and white girls: The National Heart, Lung, and Blood Institute Growth and Health Study

OBJECTIVE To (1) describe anthropometric and body-size measurements in the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS) population at baseline and (2) examine potential secular trends in the prevalence of obesity in young black and white girls by comparing NGHS baseline data with those of the two National Health and Nutrition Examination Surveys (NHANES I and II) (measured before the NGHS). DESIGN Cross-sectional analysis of cohort baseline data. SETTING Recruitment in selected schools (Cincinnati and Berkeley) and among the membership of a group health association (Westat). PATIENTS Enrolled 2379 girls, 9 and 10 years of age, including 1213 black and 1166 white. MEASUREMENTS Anthropometric measures, including height, weight, and triceps and subscapular skin folds. Body mass index was used as a measure of body size. Nine- and ten-year-old black girls were taller, heavier, and had larger skin folds than white girls. Compared with age-similar girls in the 1970s, girls in the present study are taller and heavier and have thicker skin folds. The differences in body size were most notable among black girls. CONCLUSIONS Black girls have a greater body mass than white girls even as young as 9 and 10 years of age. The prevalence of obesity appears to be increasing among young girls, especially in black girls. This progression, if not altered, could lead to increased disease in the future for adult women, particularly black women.

AN AIR DISPLACEMENT METHOD OF MEASURING BODY VOLUME IN BABIES: A PRELIMINARY COMMUNICATION.

We are involved in the study of human growth at the Child Development Unit of the University of Louisville, with some cooperating international studies, who have all agreed to measure the same multidisciplinary parameters in the same way at the same time on longitudinally studied healthy children from birth. \Ye are also specifically studying the withinpair differences, again on a multidisciplinary basis, of like sexed identical and nonidentical human twins followed from birth. We originally supposed, while making a series of fundamental mistakes, that environment may only alter a growth pattern after birth has occurred. We have rapidly learned that because one shares the same uterus with another genetically identical animal, the environment may indeed be very different for one twin compared to the other. To oversimplify and summarize the aims of our twin studies, they are to determine the relative weighting of genetic and environmental factors upon patterns of human growth. I t is clearly essential for us, on the physical side of the study, to determine the body composition of our young twins. One identical twin is so commonly born as a “premature baby” with the other weighing at birth, say, six pounds-a further demonstration of the unhelpful definition of prematurity by weight. We have found placental nutrition and blood supply an important factor in such differences but we need urgently to determine what such weight and size differences (in genetically identical babies) truly indicate. We have therefore tried to develop a simple, quick, and relatively cheap method of determining, as a preliminary step, the total body volume of our babies. The nightmares associated with longitudinal studies concern loss from the sample. Parents and newborn twins themselves are long suffering volunteers-they would be unlikely to return for followup visits if weighed underwater. We have naturally reviewed all possible methods, and we are indeed grateful to many experts who have given much of their time and skills. I will not review all of the literature which is well known to you except to remind you of Archimedes in the baths of Syracuse, and J. Robertson, a London physician, who in 1757 wrote an essay on “Towards ascertaining the specific gravity of living men.” A quote from a description reads: “he . . . bribed ten middling sized men. . . for the most part very thin and slim made persons to duck under water in his tank . . . (But) Robertson himself was not satisfied with the results and complained of the unco-operativeness of his subjects, who seemed more interested in the bribe than in the experiment .” We turned to a re-examination of the principles of the air-displacement

Intra-Uterine Blood Transfer between Uniovular Twins

The non-haemolytic anaemias of the newborn have recently attracted the attention of many investigators. Of particular interest has been the anaemia due to occult blood loss of the foetus into the maternal circulation (Wiener, 1948; Chown, 1954; Gunson, 1957. Another type of intrauterine occult blood loss has been recognized in the last few years as being due to transfusion of blood from one uniovular twin to the other through anastomotic vessels in the placenta (Herlitz, 1942; Bosma, 1954; Klingberg, Jones, Allan and Dempsey, 1955; Bergstedt, 1957; Betke, Deibel and Schlicht, 1958; Sacks, 1959). The present paper describes a similar case and our attempts to rectify it.

The physical development of the premature infant. I. Some standards and certain relationships to caloric intake.

Summary Some standards of physical development in the first year of life (at birth, 13, 26, 39, and 52 weeks) are presented for 3 birth weight groups of premature infants—0 to 2.9 pounds; 3.0 to 3.9 pounds; and 4.0 to 5.5 pounds. These are means of weight and of measurements of lying length, crownrump, head circumference, and fibula length (obtained by fibulometry). Mean 13-week increments of these measures are also given. Standard deviations of the means are given. The stem-stature indices of the infants, with standard deviations, are presented. These measures are discussed in relationship to each other and in comparison to those of full-term babies. The premature baby of a given weight group appears to maintain his birth weight and length status in relationship to premature babies of other weight groups and to full-term infants. Demonstration and study of the similarities of rates of growth in three weight groups of premature infants and in full-term infants emphasize this pattern. The head circumference of the premature infant appears to have reached average fullterm size by 3 months after being very much smaller at birth. The stem-stature indices of the three weight groups of premature infants are very similar yet behave oddly in their pattern of development. They are comparable at birth to an average one-year-old full-term baby. There is an unusual increase to 3 months of age, which is followed by the usual decrease. These findings are discussed. Fibula length, obtained by fibulometry, appears to be a constantly reliable measure of linear growth. It is highly repeatable and accurate. Its correlation with lying length is given and discussed. Two groups of premature babies were given formulas of different concentrations but of the same volume. Irrespective of birth weight group, those offered and taking the stronger formula (average, 42 calories per unce) had a greater gain in weight and hence a highly significant shorter hospital stay than those taking the weaker formula (average 26 calories per ounce). There was a more rapid gain in weight in the shorter-stay group. Reasons for this with advantages and disadvantages in increased caloric feeding are discussed.

CAN RELATIVELY SIMPLE ANTHROPOMETRIC AND RADIOGRAPHIC MEASURES YIELD RELIABLE INFORMATION ON BODY COMPOSITION

The title of my paper is “Can relatively simple anthropometric and radiographic measures yield reliable information on body composition?” I am tempted to make a record of the shortest paper ever to be published in the Annals of the New York Academy of Sciences: My paper would then be a one-word presentation: “No.” I could still no doubt establish a record by making it a little longer and having it read: “No, apparently-at least not yet.” The subject is of vital importance to many investigators who are interested in the basic problems of human growth and developmental genetics; and this means changes in growth patterns during development. Wedgwoods (1963) concept of an individual child being a continuum of growth from the moment of conception is admirable-though I felt the author who clearly influenced him in his illustration: ‘a child dying a little every day’-made me feel a little eerie. Ibsen is perhaps too macabre. Many investigators have, as myself, neither the skills nor the budget to investigate in detail by highly elegant (and admirable) methods body components on the comparative large numbers of healthy, sick, and twinborn children that we see and investigate. We have come a long way ( I do so fervently hope) from measuring, and dwelling upon, height, weight, and head circumference in the baby. We routinely take 12 anthropometric measures on our samples of children and twin-children; and we take some soft tissue radiographs. We hope we have indications of bone, fat, and muscle growth on our punch cards. But have we? If we have not, should we continue with these laborious procedures? We have always taken our anthropometry, photogramme try, and radiographic measures very seriously and strive for accuracy and the elimination of errors. While we are proud of these studies, are we wasting time of investigator, of volunteer, and of sick child? If in reviewing some of the problems presented in the literature I only refer to some few special examples, omissions occur only because the literature is so full of anthropometric and radiographic data pertinent to our discussion; and because those I have chosen will serve very adequately to illustrate certain basic points. Subcutaneous fat is difficult to measure. Those of us who work with subcutaneous fat calipers-be they Harpenden, Lange, Franzen-know that choice of site, newborn and premature babies, very obese subjects, are examples of nagging difficulties. Indeed we have shown, in the newborn, that pinching at a site, either in error or on purpose, 0.5 cm. away from the

Qualitative changes in the cisternal and lumbar spinal fluid following an intravenous injection of glucose in apparently “healthy” children

Summary Qualitative glucose determinations were carried out on lumbar and cisternal cerebrospinal fluid in 17 normal children over a time period of about 1 hour after an intravenous injection of glucose. Normative means and standard deviations of the glucose levels are given. The changes in levels over 10 minute time periods follow a characteristic pattern and are presented.