"Land and Food Systems, Faculty of"@en . "DSpace"@en . "UBCV"@en . "Rabeneck, Sonya"@en . "2010-02-08T21:43:53Z"@en . "1976"@en . "Master of Science - MSc"@en . "University of British Columbia"@en . "A cross-sectional growth study was designed to obtain information on the growth patterns of British Columbian Native Indian children. The object of the study was to establish whether growth patterns of B.C. Native Indian children living in student residences correspond to those of non-Indian reference children. The study sample consisted of all children 6 to 17 years attending the six student residences administered by the Department of Indian and Northern Affairs. The total sample size was 734 children, representing 77 reserves in the province. Standing height, sitting height, weight, arm circumference, four skinfold thicknesses (triceps, subscapular, biceps and suprailiac), and head circumference were measured according to the recommendations of the International Biological Program (Weiner and Lourie, 1969). Arm muscle diameter, circumference and area were derived according to the method of Frisancho (1974). Individual findings were plotted, as scatter diagrams against standard reference curves, data for which was obtained from Caucasian children.\nResults indicate a considerable growth deficit in standing and sitting height in younger children which appears to be somewhat corrected by adolescence. Weight measurements, although falling predominantly below the Iowa mean, generally reflect adequate gain with age. Arm measurements indicate well maintained musculature throughout the age-range studied, with relatively low degrees of triceps adipose tissue. Head circumference displays an initial deficit in younger children which is largely corrected by adolescence. It was concluded that protein nutritional status of B.C. Native Indian children living in student residences may be relatively better than calorie nutritional status."@en . "https://circle.library.ubc.ca/rest/handle/2429/19817?expand=metadata"@en . "GROWTH OF BRITISH COLUMBIAN NATIVE INDIAN CHILDREN AS ASSESSED FROM ANTHROPOMETRIC MEASUREMENTS by SONYA RABENECK B.Sc, University of B r i t i s h Columbia, 1974 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE i n the Di v i s i o n of HUMAN NUTRITION SCHOOL OF HOME ECONOMICS We accept t h i s thesis as conforming to the required standard. THE UNIVERSITY OF BRITISH COLUMBIA May, 1976 In presenting th i s thesis in pa r t i a l fu l f i lment of the requirements for an advanced degree at the Un ivers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make it f ree l y ava i l ab le for reference and study. I fur ther agree that permission for extensive copying of th i s thes is for scho lar ly purposes may be granted by the Head of my Department or by his representat ives. It is understood that copying or pub l i ca t ion of th is thes is fo r f i nanc ia l gain sha l l not be allowed without my wr i t ten permission. Department of The Un ivers i ty of B r i t i s h Columbia 20 75 Wesbrook Place Vancouver, Canada V6T 1WS Date M^M. S i l \u00C2\u00B0 ! ^ > -i ABSTRACT A cross-sectional growth study was designed to obtain information on the growth patterns of B r i t i s h Columbian Na-t i v e Indian children. The object of the study was to esta-b l i s h whether growth patterns of B.C. Native Indian children l i v i n g i n student residences correspond to those of non-Indian reference children. The study sample consisted of a l l children 6 to 17 years attending the six student r e s i -dences administered by the Department of Indian and Northern A f f a i r s . The t o t a l sample size was 734 children, represent-ing 77 reserves i n the province. Standing height, s i t t i n g height, weight, arm circumference, four s k i n f o l d thicknesses (triceps, subscapular, biceps and s u p r a i l i a c ) , and head c i r -cumference were measured according to the recommendations of the International B i o l o g i c a l Program (Weiner and' Lourie, 1969). Arm muscle diameter, circumference and area were de-riv e d according to the method of Frisancho (1974). I n d i v i -dual findings were plotted, as scatter diagrams against stan-dard reference curves, data for which was obtained from Caucasian children. Results indicate a considerable growth d e f i c i t i n standing and s i t t i n g height i n younger children which ap-pears to be somewhat corrected by adolescence. Weight measurements, although f a l l i n g predominantly below the Iowa mean, generally r e f l e c t adequate gain with age. Arm measure ments indicate well maintained musculature throughout the age-range studied, with r e l a t i v e l y low degrees of t r i c e p s adipose t i s s u e . Head circumference displays an i n i t i a l de-f i c i t i n younger children which i s l a r g e l y corrected by adol scence. I t was concluded that protein n u t r i t i o n a l status of B.C. Native Indian children l i v i n g i n student residences may be r e l a t i v e l y better than c a l o r i e n u t r i t i o n a l status. ACKNOWLEDGEMENTS To my research d i r e c t o r Dr. Melvin Lee, I extend my sincere thanks for h i s guidance, and encouragement so gener-ously offered throughout the course of t h i s project. In addition, I would l i k e to express my appreciation to Dr. K. Damji and to Dr. B. A l f r e d for t h e i r help i n the preparation of t h i s t h e s i s . I would e s p e c i a l l y l i k e to thank Mr. Edward R. Powell for h i s very kind help i n developing computer pro-grams for the data analysis. I am gratef u l to the Medical Services Branch ( P a c i f i c Region) of the Department of National Health and Welfare, and to the administrators and s t a f f of the six r e s i d e n t i a l schools v i s i t e d , for t h e i r assistance and cooperation i n the data c o l l e c t i o n . F i n a l l y , I would l i k e to thank the children who pa r t i c i p a t e d i n t h i s study; without t h e i r enthusiasm and cheerful cooperation, my thesis could not have been accom-plish e d . i v TABLE OF CONTENTS Page ABSTRACT i ACKNOWLEDGEMENTS i i i LIST OF FIGURES V Chapter I REVIEW OF LITERATURE 1 Anthropometric Parameters 1 Assessment of Native Indian Populations 13 1. U.S. Native Indians 13 2. Canadian Native Indians 18 II INTRODUCTION 2 3 III MATERIALS AND METHODS 29 IV RESULTS 34 V DISCUSSION 65 VI SUMMARY AND RECOMMENDATIONS 79 BIBLIOGRAPHY 81 APPENDICES Legends to Appendices 92 A Standing height, s i t t i n g height, s i t t i n g height/ standing height r a t i o and weight (sorted accord-ing to sex and age) 96 B Skinfold thicknesses (sorted according to sex and age) I l l C Arm circumference, upper arm muscle dimensions and head circumference (sorted according to sex and age) 126 V LIST OF FIGURES Figure Page 1-1 Standing height of males 45 1-2 Standing height of females 46 I I - l S i t t i n g height of males 47 II-2 S i t t i n g height of females 48 I I I - l Weight of males 49 III-2 Weight of females 50 IV-1 Triceps sk i n f o l d thickness of males 51 IV-2 Triceps s k i n f o l d thickness of females 52 IV-3 Subscapular s k i n f o l d thickness of males 53 IV-4 Subscapular s k i n f o l d thickness of females 54 V - l Arm circumference of males 55 V-2 Arm circumference of females 56 V3T-1 Upper arm muscle diameter of males 57 VI-2 Upper arm muscle diameter of females 58 VI-3 Upper arm muscle circumference of males . 59 VI-4 Upper arm muscle circumference of females 60 VI-5 Upper arm muscle area of males 61. VI-6 Upper arm muscle area of females 62 VII-1 Head circumference of males 63 VII-2 Head circumference of females 64 1 CHAPTER I REVIEW OF LITERATURE Anthropometric Parameters N u t r i t i o n a l anthropometry deals with the measure-ment of body composition and dimension, at d i f f e r e n t l e v e l s of n u t r i t i o n a l status, from b i r t h to adulthood. I t i s well accepted that growth and therefore p o t e n t i a l body size are la r g e l y determined by genetic factors, however, a number of environmental influences are seen to act upon t h i s po-t e n t i a l for growth. Among these i s n u t r i t i o n . Retarda-t i o n of growth and development i s one of the consequences of n u t r i t i o n a l deprivation, while altered growth patterns are observed i n the overnourished. Thus, anthropometric measurements are a valuable t o o l i n the assessment of growth and development and r e f l e c t adequacy of the n u t r i -t i o n a l state. Anthropometric techniques are widely used i n the assessment of growth and development of both the i n d i v i -dual, and of groups of i n d i v i d u a l s . A l t e r a t i o n s of body size and composition during the growth period of an i n -dividual can be assessed by s e r i a l measurement of one or more parameters (allowing conclusions to be drawn about 2 the rate of growth) or by single measurement of attained dimension which i s subsequently compared with standard values. Two important points are well recognized i n the inte r p r e t a t i o n of such information, as stressed by Falkner (1962). F i r s t , standard curves, by nature of t h e i r con-struction, do not show the in d i v i d u a l patterns of each c h i l d , and are therefore presented as smooth curves with few dramatic changes. In comparison, the growth chart of an i n d i v i d u a l c h i l d w i l l display some i r r e g u l a r i t i e s while the c h i l d i s growing normally. Second, although the range of average l i m i t s (or d i s t r i b u t i o n of percentile curves) gives points within which we can expect thewraeasurements of a healthy i n d i v i d u a l to f a l l , there i s no well defined c r i t e r i o n f or abnormal growth of the i n d i v i d u a l . Thus, while a c h i l d ' s measurements f a l l i n g outside established l i m i t s provides some value i n assessing his progress, i n -terpretation of the adequacy of growth i s to be made with caution. In the assessment of growth and development of a group of in d i v i d u a l s , although the parameters measured and techniques employed are sim i l a r to those i n i n d i v i d u a l assessment, conclusions regarding growth status are made i n other ways. In group analysis, information can be ob-tained on the generalggrowth trends of the group which mean values are compared s t a t i s t i c a l l y with means of a w e l l -nourished population. Thus, for example, mean height values 3 for a group of individuals might indicate generally t a l l e r or shorter stature, at c e r t a i n ages or throughout the growth period, as compared with the mean height values of reference c h i l d r e n . In addition, information relevant to the proportion of in d i v i d u a l s within the sample who show inadequate growth status can be obtained. Findings of t h i s nature can then be interpreted i n the l i g h t of i n -formation regarding c e r t a i n n u t r i t i o n a l factors known to a f f e c t the study sample. Although numerous anthropometric measurements are recognized, c e r t a i n of them are recommended as being of p a r t i c u l a r value i n the assessment of growth and develop-ment of a population. Growth i n l i n e a r dimension i s com-monly measured by standing height and s i t t i n g height. Measurement of s i t t i n g height allows determination of the r e l a t i v e contribution of head and trunk to t o t a l stature, through determination of the s i t t i n g height/standing height r a t i o . Measurement of weight provides information on the t o t a l body mass, although t h i s i s a gross measure of s i z e . More s p e c i f i c information can be obtained on the growth of various regions of the body. Arm circumference and head circumference measurements are widely used for t h i s purpose, while measurement of chest circumference i s considered important for preschool children. Changes i n s p e c i f i c body compartments during growth can also be ob-tained with anthropometric techniques. Skinfold measurements 4 i n c e r t a i n well defined regions of the body provide informa-t i o n regarding deposition of subcutaneous adipose tissue; while arm muscle diameter, circumference and area ( a r i t h -metically derived from tr i c e p s s k i n f o l d and arm circumfer-ence measurements) provide useful information on growth of upper arm muscle. 1. Standing height and s i t t i n g height. In part, because i t i s growth cumulative and i n part, because the measuring error i s r e l a t i v e l y small, Garn (1973) considers the simple measurement of standing height \"a more sensitive group indicator of n u t r i t i o n a l status during the growing period than anything we conveniently measure i n the serum or recover from the urine.\" This author considers stand-ing height, or recumbent length i n the infant to be the most frequently measured parameter of body size during the growing period. I t i s well documented that children from well nourished populations stand consistently t a l l e r than children from poorly nourished groups, and that boys and g i r l s of the middle and upper socioeconomic classes are t a l l e r than those of the lower classes. This has been shown for populations from Nigeria (Rea, 1971; Janes, 1974), Ethiopia (Ekmyr, 1970), Costa Rica ( V i l l a r e j o s et a l . , 1971), Tunisia (Lowenstein and O'Connell, 1974), Iran (Amirhakimi, 1974), Guatemala (Johnston et a l . , 1973), Turkey (Neyzi et a l . / 1973), and Nepal (Farquharson, 1976). Thus i n developing countries, where the chi l d r e n of the 5 highest socioeconomic group are l e s s l i k e l y to be burdened with severe n u t r i t i o n a l d e f i c i e n c i e s , the stresses of d i s -ease (Scrimshaw et a l . , 1968), and of other detrimental s o c i a l conditions (Christiansen et a l . , 1975), \u00E2\u0080\u00A2ygrowth i n height i s greater than i n les s advantaged c h i l d r e n . Data from developed countries show that stature i s s i m i l a r l y r elated to economic l e v e l . The Ten State N u t r i -t i o n Survey (1968-1970) revealed that mean heights for white children and adolescents were greater for the high-income - r a t i o group than for the low-income-ratio group. This was observed within various subsamples though at some-what d i f f e r e n t l e v e l s for blacks, whites and Meso-Americans. Si m i l a r l y , Owen et a l . (1974), i n the Preschool N u t r i t i o n a l Status Survey, reports that height expressed i n terms of age- and sex-specific Z-scores, increases over the four Warner Ranks used to categorize socioeconomic status. Fur-ther, Jose and Welsh (1970) have reported that among pre-school Australian children, those of high socioeconomic status have greater mean heights than those of the low socioeconomic group. Social class differences i n height have also been established for English children. Goldstein (1971) reported a difference i n height for both sexes, bet-ween the highest and lowest s o c i a l c l a s s , of 1.3 cm (fa-voring the advantaged child) for 7 year olds a f t e r allow-ing for the e f f e c t s of pa r i t y , mother's height and number of s i b l i n g s . The authors state that t h i s difference r e f l e c t s 6 other influences r e l a t e d to s o c i a l c l a s s . Height measurements generally show les s v a r i a b i l i t y than do some other anthropometric parameters when taken on a group of i n d i v i d u a l s . Gwynn and Sanjur (1974) have shown that standing height measurement of malnourished Colombian children display much smaller deviations from standard values of reference children than do other para-meters measured. As stated by the authors, the s e l f -evident explanation for t h i s may be that height, once gained cannot be l o s t , while the opposite i s true for other anthro-pometric parameters such as weight. Thus standing height measurement can be considered a l e s s discriminating para-meter for the assessment of growth, although low height for age, coincident with normal weight for height, has been used as a dependable indicator of past chronic protein-c a l o r i e malnutrition (Seone and Latham, 1971). Body proportion, as determined by the r e l a t i v e contribution of s i t t i n g height to stature and by sexual dimorphism i n stature i n poorly nourished groups, however, displays l i t t l e difference from that of well-fed populations. S t i n i (1972) has shown, i n a comparison of data on various populations l i v i n g i n a wide range of environments, that these body proportions are r e l a t i v e l y constant among the groups. The authors state that t h i s i s due to d i f f e r e n t i a l growth rates i n males and.females; males growing more slowly but for a longer period of time under stress. Thus, 7 i n a pr o t e i n - d e f i c i e n t Colombian population cross-sectional data indicate that a delay i n s k e l e t a l maturation i n males far exceeded that observed i n females ( S t i n i , 1969). Des-p i t e i t s lack of v a r i a b i l i t y , measurement of s i t t i n g height among .groups of i n d i v i d u a l s allows further descrip-t i o n of physique during the growing period, and i s valuable i n group assessment. 2. Body weight. Growth and development during c h i l d -hood and adolescence i s r e f l e c t e d i n a systematic and char-a c t e r i s t i c gain i n body weight, which i s well correlated to dimensional changes throughout the body (Tanner, 1962). On an i n d i v i d u a l basis a s e r i a l weight record gives the e a r l i e s t objective evidence of malnutrition (Church and S t a n f i e l d , 1971) and the c h i l d ' s weight graph has been demonstrated to be a most useful a id i n children's c l i n i c s in. developing countries (Cole-King, 1975; Yankauer, 1975). In group assess-ment, measurement of body weight i s an indispensable para-meter of anthropometry. According to J e l l i f f e (1967), weight measurements i n poorly nourished groups should be combined with c l i n i c a l examination or with other appropriate measurements. Body weight when considered i n r e l a t i o n to the expected weight for height, provides a means of assess-ing the degree of harmony between these two measurements. Addy (1970) has shown that weight-for-height i s l e s s a f f e c -ted than weight-for-age and may probably be a better i n d i -cator of the actual n u t r i t i o n a l process occurring i n the 8 c h i l d . A l t e r n a t i v e l y , they may be r e f l e c t i n g d i f f e r e n t stages of the n u t r i t i o n a l state since there i s a low degree of c o r r e l a t i o n between these two measurements i n malnourished children (Dugdale et a l . , 1970; Gwynn and Sanjur, 1974). It i s known that body weight i s vulnerable to n u t r i -t i o n a l i n s u l t of both short and long duration, and i s af-fected i n states of disease, such as i n f e c t i o n (Cravioto et a l . , 1967). This e f f e c t i s due i n part to i n h i b i t i o n of nutrient u t i l i z a t i o n , enhanced tissue breakdown or a combi-nation of both. Despite t h i s apparent l a b i l i t y of body weight, however, Sohar et a l . (1973) have shown, i n a study sample of 404 children i n Tel Aviv, that there i s a high degree of c o r r e l a t i o n between body weight of each c h i l d at age 6 to 7 and at age 13 to 14; a c o r r e l a t i o n which e x i s t s for both obese and nonobese c h i l d r e n . S i m i l a r l y , the per-sistence of excess body weight from infancy to adulthood has been emphasized (Mullins, 1958; E i d , 1970). Thus, body weight measurement, as a t o o l i n the assessment of growth, provides a composite index of a population, r e f l e c t i n g both the current n u t r i t i o n a l status and the general pattern-of weight accruement. 3. Skinfold thickness. Since various components of the human body respond d i f f e r e n t i a l l y to n u t r i t i o n a l adequacy or deprivation during growth and development,, anthropometric measurements more s p e c i f i c i n nature are of value i n the assessment of these processes. The measurement of s k i n f o l d 9 thickness i s based on the assumption that increased subcu-taneous f a t , due either to low energy expenditure or high c a l o r i e intake, or to a combination of both, r e f l e c t s a greater energy reserve. A number of studies have been made of the c o r r e l a t i o n between skin f o l d measurements and t o t a l body fat as determined by other methods (Hammond, 1955; Brozek and Keys, 1951; Pascale et a l . , 1956; Hermansen and Dobeln, 1971). These studies show correlations of between 0.50 to 0.98. However, i t i s stressed by Ward et a l . (1975) that one cannot expect to know the actual amount of body fa t , as i s possible with animal studies, and that one i s l i m i t e d to comparison of methods of p r e d i c t i o n . These are useful procedures, however, since i n some large populations the prevalence of obesity due to overnutrition i s a major concern. Durnin and Rahaman (1967) have shown that the re-l a t i o n s h i p between body density, and hence body f a t , and s k i n f o l d thickness i s s u f f i c i e n t l y uniform to allow con-struction of regression equations and tables to calculate percentage of body weight as f a t , on t h i s b a s i s . In a f u r -ther study (Durnin and Womersley, 1974), these workers showed that the.measurement of a single s k i n f o l d (triceps) provides p r e d i c t i v e power equal to that of four t o t a l skin-f o l d s . Skinfold measurement i n the neonate has further shown to be a useful method for noninvasive investigation of 10 p e r i n a t a l body composition and n u t r i t i o n (Brans et a l . , 1974). Decrease i n the proportion of body weight a t t r i -butable to water, and fat deposition i n subcutaneous and i n t e r n a l body stores are seen to be normal changes i n body composition during f e t a l l i f e . Further, lower fat stores and expansion of a l l body water compartments r e s u l t from intrauterine growth retardation. This has allowed the sug-gestion, by these authors, that s k i n f o l d thickness measure-ment recorded at various times a f t e r application (with changes noted due to compressibility) of the c a l i p e r s pro-vides an estimation of both fat. stores and subcutaneous i n t e r s t i t i a l water. Children of greater adiposity for t h e i r age are both t a l l e r and developmentally more advanced than average children (Garn and Haskell, 1960). This i s supported by animal experimental studies demonstrating that overnutri-t i o n brings e a r l i e r s k e l e t a l maturity and greater dimen-sional growth (Hammond, 1954). However, because measure-ment of s k i n f o l d thickness of c h i l d r e n of poorly nourished groups reveals l e s s subcutaneous f a t , i t has been suggested that evaluation of growth based upon s k i n f o l d thickness i s le s s sensitive among such populations. Thus Frisancho and Garn (1971) report that only those children with t r i c e p s s k i n f o l d below the 5th or above the 95th percentile show systematic differences i n standing height i n a sample of Guatemalan r u r a l c h i l d r e n . In other words, the r e l a t i o n s h i p 11 between degree of adiposity and growth i s not l i n e a r , and ski n f o l d thickness i s not a valuable correlate of growth for studies among these c h i l d r e n . This does not appear to be 'due to differences i n d i s t r i b u t i o n of fat deposition since the same re s u l t s were obtained from measurement of subscapular s k i n f o l d . Similar data have been reported among children from Costa Rica (Frisancho et a l . , 1971) and Honduras (Frisancho and Garn, 1971). However, s k i n f o l d measurements, p a r t i c u l a r l y those taken at the t r i c e p s and subscapular, are considered by J e l l i f f e (1966) to be of great importance i n the assessment of n u t r i t i o n a l status of a community. 4. Arm circumference. Measurement of upper arm circumference has received much attention i n the l i t e r a t u r e as being an important t o o l i n anthropometry. Many studies have been made to assess the v a l i d i t y of measuring arm c i r -cumference as a means of determining the n u t r i t i o n a l status of a population, as summarized by Loewenstein and P h i l l i p s (1973). Comparing r e s u l t s of arm circumference measurement with c l i n i c a l evaluation and with other anthropometric para-meters (such as weight, weight/age and weight/height), the authors concluded that arm circumference measurement i s of value for three purposes: 1) rapid assessment of n u t r i -t i o n a l status of a geographic area, 2) screening of a large group for those i n d i v i d u a l s requiring immediate attention, 3) evaluation of the effectiveness of ongoing programs 12 designed to improve the n u t r i t i o n a l status of a group. S i m i l a r l y , J e l l i f f e (1969) has stressed i t s value i n iden-t i f i c a t i o n and c l a s s i f i c a t i o n of children with various de-grees of p r o t e i n - c a l o r i e malnutrition. Frisancho (1974) has shown that, compared with height and weight, arm circumference shows very l i t t l e change between ages 1 and 5 years (as indicated by Burgess and Burgess, 1969) and that exact knowledge of chronologi-c a l age may not be necessary for evaluation of n u t r i t i o n a l status based upon t h i s measurement. 5. Arm muscle measurements. Other soft tissues of the body, most notably muscle, display s p e c i f i c changes during n u t r i t i o n a l deprivation as well as c h a r a c t e r i s t i c patterns during normal growth and development and provide useful measurement i n group assessment. Studies by Waterlow and Mendes (1957) show that reduction of body weight i n infants on a p r o t e i n - d e f i c i e n t d i e t i s exceeded by a de-crease i n muscle mass, as determined through either limb measurement or creatinine output. According to work car-r i e d out on six children h o s p i t a l i z e d with kwashiorkor, and then v e r i f i e d i n the laboratory r a t , Castellanos and Arroyave (1961) have shown that t h i s reduction i n muscle size provides amino acids for gluconeogenesis and protein synthesis i n the l i v e r . In addition, with n u t r i t i o n a l re-h a b i l i t a t i o n the calculated increase i n muscle size i s s i g n i f i c a n t l y correlated with increased urinary-outputs of 13 creatinine, considered the most d i r e c t biochemical index of muscle mass (Standard et. a l . , 1959). Frisancho (1974) provides data showing that muscle size , when expressed as muscle diameter or circumference for children age 1 to 12 years tend to underestimate the mag-nitude of tissue growth, compared with trends displayed by increase i n muscle area. Further, greater muscularity i s related to greater stature and thus arm muscle measurements can be considered an acceptable general index of growth. In summary, n u t r i t i o n a l anthropometry provides a useful means of assessing body dimensional changes .of an in d i v i d u a l or population during growth and development and during various stages of n u t r i t i o n a l adequacy or deprivation. Assessment of Native Indian Populations 1. U.S. Native Indians Although there i s an established need for information concerning the adequacy of growth among B r i t i s h Columbian Indian children, and of Canadian Indian children, i n general, few studies are available i n the l i t e r a t u r e . More attention has been given Indian groups i n the United States, however much of t h i s information i s based upon small samples (Vavich et a l . , 1954; Perkins and Church, 1960) or l i m i t e d age range (French, 1967; Mayberry and Lindeman, 1963; Wenberg et a l . , 1965) . Height and weight were measured i n a sample of 1,200 14 children between 6 and 11 years of age i n the Blackfoot Indian Reservation N u t r i t i o n Survey (1964), a study car-r i e d out by the Interdepartmental Committee on Nu t r i t i o n for National Defense (ICNND). The sample was divided ac-cording to sex, and between 31 and 63 children were i n each one year group. Heights and weights c l o s e l y approximated those of Iowa reference children. In the same study, mean heights of 82 preschool boys from the same reserve were compared with Iowa standards for height. Values were con-s i s t e n t l y more than one standard deviation below the Iowa mean af t e r age 1. Mean weight f e l l below the Iowa mean aft e r 6 months of l i f e . Among a sample of 85 preschool g i r l s mean heights and weights were between the Iowa mean and 1 standard deviation below the mean throughout the age range studied. Children from the Fort Belknap Indian Reservation (1964) showed similar growth patterns. These data were derived from equal numbers of Gros Ventres and A s s i n i -boin Indian children i n north central Montana. The sample was divided according to sex and between 14 and 28 children were measured i n each one year group. Average height and weight values were consistently at or above Iowa means for both sexes, with boys of 9 to 11 years tending to weigh more than reference boys. The preschool children, however, showed a marked growth d e f i c i t . In a more recent study c a r r i e d out i n 1973 on the Blackfoot Reservation (Nichaman et a l . , 1975), growth data 15 were obtained from 1,261 children, aged 6 to 17 years. Height-for-age d i s t r i b u t i o n s , when compared with Iowa standards, were found to be normal. Weight-for-height, however, was skewed toward the higher percentiles, as was weight-for-age. U t i l i z i n g the method of c l a s s i f i c a t i o n of Waterlow (1972), 6.7 percent were found to be retarded i n height-for-age while 0.8 percent were acutely malnour-ished and a further 11.5 percent of the group were over-weight. Owen et a_l. (1972) completed an important growth study of 201 preschool children from 125 fami l i e s , members of the White Mountain Apache Tribe i n Arizona. These authors found that 38 percent of the heights were below the 10th percentile for reference children, although s k e l e t a l mat-uration was normal, while 3 percent f e l l above the 90th p e r c e n t i l e . Weight measurements revealed 18 percent to be below the 10th percentile while 7 percent were above the 90th percentile for reference c h i l d r e n . When compared with Negro preschool children i n low-income r u r a l areas of Missis -s i p p i (Owen et a l . , 1969), the Apache children are seen to be considerably shorter; among the Negro group 24 percent had heights below the 10th p e r c e n t i l e . Head circumferences of Apache children, of both sexes, were below average values of reference c h i l d r e n of Nellhaus (1968). Comparatively more data are available for Navajo Indian children than for other Indian groups i n the United 16 States. This group i s now the largest within the boundaries of the United States. Darby et a l . (1956) reported average height and weight of school-aged children, compared to a Canadian sample (Pett, 1955) and revealed that Canadians were consistently t a l l e r by 3 to 4 inches for childr e n from 10 years of age to l a t e adolescence. U n t i l the age of 10 years there was no s i g n i f i c a n t difference i n height between the groups regardless of sex. Comparison of average weight s i m i l a r l y favoured the Canadian c h i l d ; from 8 years of age onwards the Navajo boys weighed 3 to 22 pounds l e s s than t h e i r Canadian counterparts. When expressed as 'percent of standard' using the Baldwin-Wood tables (Bigwood, 1939) for U.S. children, increasing a?ge, for both sexes, was associated with an increasing percentage of subjects less than 90 percent of standard. For males, about 20 percent of the sample were les s than 90 percent of standard at 5 years while almost 35 percent were les s than 90 percent of standard at 15 years. For females, the proportion l e s s than 90 percent increased from 15 percent of sample at 5 years to about 20 percent at 15 years. A recent study of 944 Navajo children between the ages of 4 and 7 years, on the Head Start program, from a l l parts of the reservation (Van Duzen e_t a l . , 1969),revealed that nearly one t h i r d of them were below the 3rd percentile of Iowa standards for height, while one tenth were below the 3rd percentile for weight. In a l l cases, the differences between observed and expected height and weight v/ere s t a t -i s t i c a l l y s i g n i f i c a n t (P<0.01). The authors f e l t that t h i s retardation i n growth was the end r e s u l t of chronic c a l o r i e and protein malnutrition, and repeated b a c t e r i a l and v i r a l i n f e c t i o n s . Similar findings among preschoolers as well as older childre n also from the Navajo group were obtained i n a study by Reisinger et a l . (1972). A l l age groups for both sexes had a considerable excess of ind i v i d u a l s below the 50th percentile for height and weight when compared with National Health Examination Survey standards (Hamill et a l . , 1970). Thus, 20 percent of boys and 15 percent of g i r l s between 2 and 4 years of age were below the 3rd percentile for weight. For children between 5 and 9 years of age, the percentage of boys and g i r l s below the 3rd percentile for weight was 16 and 11, respectively. The authors comment that although t h i s may represent catch-up growth i n that these proportions decrease (no s t a t i s t i c a l test on these trends was offered), the percent below the 50th percentile does not change s i g -n i f i c a n t l y . The authors stress that the slower rate of growth and development observed i n the Navajo group, as compared with reference children, may be caused wholly or i n part by n u t r i t i o n a l differences. No other notable studies are available concerning growth patterns of American Indian children, indeed several major n u t r i t i o n surveys c a r r i e d out i n the United States 18 exclude an Indian subsample. The National Health Examina-t i o n Survey (1967), designed to provide information on the n u t r i t i o n a l status of American children, based on a proba-b i l i t y sample of no n i n s t i t u t i o n a l i z e d children i n the Uni-ted States, excluded children l i v i n g on reservation lands set aside for use of American Indians. This was due to operational problems encountered early i n the survey. The Ten State N u t r i t i o n Survey (1968-1970), the f i r s t compre-hensive attempt to assess the n u t r i t i o n a l status of Ameri-cans, reports no anthropometric measurements taken on In-dian c h i l d r e n . S i m i l a r l y , the Health and Nu t r i t i o n Exam-inat i o n Survey (Abraham et a l . , 1975), part of a program designed to measure the n u t r i t i o n a l status of the United States population and to minitor changes i n status over time, does not report on findings s p e c i f i c to Indian c h i l -dren. The Preschool N u t r i t i o n Survey (Owen et a l . , 1974) included a t o t a l of 159 American Indian preschool childr e n between 1 and 4 years of age, representing 1 percent of o v e r a l l subjects. Although the authors state that survey sampling was designed to provide a r e a l i s t i c basis for comparisons between subsets of the sample population, meaningful r e s u l t s are not available nor i s discussion directed to Indian children on the basis of t h i s inadequat sample s i z e . 2. Canadian Native Indians With respect to Canadian Indian children, there i s 19 sim i l a r s c a r c i t y of information. Studies ca r r i e d out i n central and eastern Canada several decades ago evidenced undesirable growthcpatterns, si m i l a r to those already d i s -cussed for U.S. Indians. Vivian et a l . (1948) reported anthropometric measurements of adolescents 10 to 19 years of age i n the James Bay area. Between one half, and two t h i r d s of the g i r l s and about one t h i r d of the boys i n the two bands studied were 10 to 30 pounds underweight for height, as compared with the standards of Pett (1955). The authors suggest that the prevalence of t h i s degree of under-weight i s i n d i c a t i v e of n u t r i t i o n a l f a i l u r e . Among children under 9 years of age, most showed s a t i s f a c t o r y growth. How-ever, i n one band studied (Attawapiskat), 40 percent of g i r l s between 6 and 9 were 6 to 14 pounds l i g h t e r than ex-pected. In contrast, a l a t e r study (Best and Gerrard, 1959) of two Indian groups i n Saskatchewan reported heights and weights of 30 boys and 44 g i r l s i n r e l a t i o n to those of non-Indian school children i n Saskatoon. Results show good agreement between Indian and non-Indian c h i l d r e n . More recent research begun i n 1972 (Coodin et a l . , 1975) reports on the growth of infants and preschool c h i l d -ren i n two i s o l a t e d Indian communities i n northern Manitoba; Cross Lake Reserve and Gardin H i l l Reserves. Heights com-pared well with Iowa standards, with weights generally greater than those of reference c h i l d r e n . Mean head 20 circumferences c l o s e l y approximated the standards of N e l l -haus (1968). Regarding B r i t i s h Columbian Indian children, anthro-pometric measurements were c a r r i e d out at two Indian Re-serves, Ahousat and Anaham, as part of a comprehensive nu-t r i t i o n a l status assessment of these two groups (Birkbeck et a l . , 1971). Standing and s i t t i n g height, weight, head circumference, arm circumference and t r i c e p s \" s k i n f o l d thick-ness were measured. Standing height displayed a l a g at 2 years when compared with Iowa standards and with a non-Indian group from the Vancouver area. This growth d e f i c i t was greater for the Anaham population than for the Ahousat group, although the Anaham females showed a catch-up growth e f f e c t subsequent to an i n i t i a l height of s i g n i f i c a n t l y l e s s than standard. (This being a cross-sectional study, catch-up growth could not be demonstrated although differences among age groups were clear;) The authors stress that i n s u f f i c i e n t data were obtained for the two periods of most rapid growth, namely infancy and adolescence, to permit speculation on the meaning of the findings. S i t t i n g height measurements, when compared with stan-dards of Simmons (1944) showed a d e f i c i t at both reserves u n t i l age 10. A catch-up growth phase was again observed; despite t h i s , however, the Anaham group f a i l e d to reach standard throughout childhood. 21 Body weight measurement showed that both males and females from Ahousat compare well with standards throughout childhood and into adolescence, although females from Anaham f a l l i n the lower percentiles of standard. Head circumference of children when compared with standards of Watson and Lowry (1967), revealed a l l children from Ahousat to be within standard range, while younger females i n the Anaham group were below standard. This was corrected, how-ever, by l a t e r childhood. Arm circumference showed a close c o r r e l a t i o n with body mass although no comment was offered of i t s adequacy with reference to standards i n eith e r group sampled. Triceps ski n f o l d thickness measurements among children showed an adequate subcutaneous fat layer when compared with the standards of Tanner and Whitehouse (1962). The authors stress caution i n ascribing these growth patterns to n u t r i t i o n a l differences between the two groups studied, although the generally better trends displayed by Ahousat childre n were coincident with superior d i e t (Lee et a l . , 1971). Additional anthropometric data were obtained from Indian children at Fort St. John and at two communities i n the Yukon T e r r i t o r y by the same authors (Lee, 1975). C h i l d -ren i n a l l three areas f e l l i n the lower percentiles of standard and tended to show increasing d e f i c i t i n weight for age, as compared with standards. At the three l o c a -tions studied, head circumference and other anthropometric 22 parameters were sim i l a r to those for reference c h i l d r e n . No other growth data v are available for Canadian, and more s p e c i f i c a l l y , B r i t i s h Columbian Indian c h i l d r e n . A l -though anthropometric measurements were c o l l e c t e d on Indian children by the N u t r i t i o n Canada;'Survey (1973), these data are, as yet, unavailable. , 23 CHAPTER II INTRODUCTION The Native Indian population of B r i t i s h Columbia, consisting of about 52,000 people (Canada, 1971a) i s char-acterized i n several important ways as being a group whose need for public health education and need for health ser-vices i n general i s greater than that of the p r o v i n c i a l population as a whole. This i s supported by demographic and s o c i a l c h a r a c t e r i s t i c s , as well as c u l t u r a l and-health patterns of the Native Indians i n t h i s province, as w i l l be discussed. Although the demographic data for B.C. Native In-dians, as for Canadian Indians generally, i s somewhat i n -adequate, estimates of v i t a l s t a t i s t i c s r e f l e c t a s i t u a t i o n d i s t i n c t l y d i f f e r e n t from that of the non-Indian population of B.C. and of Canada (Piche and George, 1973). The infant mortality rate for B.C. Indians i s very high, and despite a substantial reduction i n recent years, i s s t i l l more than twice that of the t o t a l Canadian population. Indeed, infant mortality rates for B.C. Indians are higher than those for any other p r o v i n c i a l Indian groups, with the exception of the Yukon and North West T e r r i t o r i e s . The b i r t h rate of 24 B.C. Indians, although displaying a decline i n recent years, i n keeping with the Canadian.population as a whole, i s re-l a t i v e l y high: 35.4 per 1000 population i n 1970 as compared to an all-Canada rate of 17.4. Mortality rates among B.C. Indians, although d e c l i n -ing, are the highest of a l l p r o v i n c i a l Indian groups, which are i n turn higher than the Canadian population as a whole. With a dec l i n i n g mortality rate and r e l a t i v e l y high b i r t h rate, the Indian population i n Canada i s increasing r a p i d l y (3.0 percent i n 1970;as compared with 1.0 percent for the general Canadian population). The rate of annual increase for B.C. Indians i s 2.7 percent. Thus the Canadian Indian population and the B.C. Indian group are i n demographic t r a n s i t i o n . Further, the proportion of t o t a l B.C. Indians under the age of 14 i s much greater than that for the general p r o v i n c i a l population: census data show t h i s sta-t i s t i c /to be 47 percent and 13.8 percent respectively (Canada, 1971b). The Indian population of B.C. therefore displays demographic c h a r a c t e r i s t i c s of a developing nation. Other^ factors have some bearing on the need for community health and education services. There i s an i n -creasing rate of migration from reserves to urban areas, with accompanying changes i n style of l i f e . Although there i s , admittedly, d i f f i c u l t y i n assessing health r e l a t e d pro-blems consequent to t h i s s h i f t , successful adaptation to the stresses of c i t y l i v i n g i s c l e a r l y dependent upon adequate 25 health education services. Also, with continued rapid ex-pansion of the transportation and communication systems throughout the province? bringing Indians on reserve lands into close contact with the non-Indian population, the Native Indians have s p e c i f i c educational requirements i n order to meet these changes. Among those aspects of health education that are of p a r t i c u l a r importance to Native Indians i s that of n u t r i -t i o n , insofar as improvement of dietary patterns i s amenable to education and public health programs. Given that sound programming i s dependent upon adequate data pertaining to the health status of a group, i t i s e s s e n t i a l that s p e c i f i c and appropriate information be available as a basis for such planning. Relatively l i t t l e information i s available on the n u t r i t i o n a l status of B.C. Native Indians, indeed such i s the case for the Canadian and North American Indian i n gen-e r a l . The N u t r i t i o n Canada Survey (1973) reports on the n u t r i t i o n a l status of Canadian Indians on the basis of dietary, biochemical and c l i n i c a l evaluation. Generally, r e s u l t s confirm that the n u t r i t i o n a l status of Canadian Indians i s i n f e r i o r to that of the general population. Thus, vitamin C status of Native Indian infants and children from remote areas was l e s s s a t i s f a c t o r y than for the gen-e r a l population as a whole. Poor vitamin A status, inade-quate calcium intake, low i r o n reserves and poor urinary 26 r i b o f l a v i n values were also found among t h i s age group. Among adolescents, c a l o r i c intakes for Indians were consistently lower than those of the same age group of the national population. A s i g n i f i c a n t percentage of adole-scents had urinary thiamin excretions i n the range of \"mo-derate r i s k \" . Vitamin A status of adults was found to be of some concern,relative to that of the general population. Indians had lower dietary intakes than the national*sample and lower median serum vitamin A l e v e l s with a corresponding increase i n the proportion of serum values c l a s s i f i e d as \"moderate r i s k \" . I t was concluded that l i v e r stores of Indians were poor. Both calcium and vitamin D intakes were consistently lower among Native Indians. A r e l a t i v e l y larger proportion of Indian adolescent g i r l s had low ir o n stores as judged by t r a n s f e r r i n saturation values. Adult Indians, e s p e c i a l l y i n remote areas, had a higher preval-ence of low serum vitamin C l e v e l s , and lower intakes of calcium and vitamin D than did the general population. Among pregnant women, poor vitamin C status, low serum v i t a -min A l e v e l s , marginal calcium and vitamin D intakes, mar-gin a l median iron intakes, and low serum f o l a t e values characterized the Native Indian population. In view of these findings, a sound s c i e n t i f i c basis has been provided for further research into the n u t r i t i o n a l status of t h i s segment of the Canadian-population. Further, i n recognizing the need for more information on Canadian Native Indians i n general, consideration should be given to p r o v i n c i a l groups. Among the 29 bands p a r t i c i p a t i n g i n the N u t r i t i o n Canada Survey, 7 were located i n B r i t i s h Columbia, although the survey d i d not report s p e c i f i c a l l y on the nu-t r i t i o n a l status of Native Indians from B.C. There are several aspects of n u t r i t i o n a l status i n -vestigation of a population. Dietary evaluation i s useful i n determining patterns of food consumption and riutrient intakes, while c l i n i c a l assessment allows detection of nu-t r i t i o n a l deficiency signs. N u t r i t i o n a l anthropometry/ encompassing c e r t a i n techniques for the assessment of at-tained physical dimension provides information on growth patterns of an i n d i v i d u a l or group of i n d i v i d u a l s . Although growth i s affected by a large number of factors, i t i s well established that c e r t a i n growth patterns are c h a r a c t e r i s t i c of an optimally nourished population, while suboptimal nu-t r i t i o n adversely a f f e c t s the growth status of a population. As discussed i n the review of l i t e r a t u r e , studies reporting anthropometric data on Canadian Indian, populations are of very l i m i t e d sample siz e , are l i m i t e d i n terms of t h e i r representation of the B.C. Native Indian children population as a whole and are l i m i t e d i n terms of the ac-t u a l measurements taken. Indeed, there i s no study a v a i l -able aimed s p e c i f i c a l l y at B.C. Native Indian children with a view to assessing t h e i r growth patterns. Thus, the need for a study of larger sample size and of greater scope i s c l e a r . 28 The present research project therefore was designed to obtain information on the growth patterns of B.C. Native Indian children l i v i n g i n student residences. The objective of the study was to e s t a b l i s h whether the growth patterns of B.C. Native Indian children l i v i n g i n student residences correspond to those of non-Indian reference c h i l d r e n . The study sample consists of a l l children, aged 6 to 17 years, attending the six student residences for Native Indian c h i l d -ren i n B r i t i s h Columbia. Total sample size i s 734 children, representing approximately 4.3 percent (Canada, 1970) of the entire population of Native Indian children i n B r i t i s h Columbia. The study i s cross-sectional i n design, u t i l i z -ing standard anthropometric techniques for the assessment of standing and s i t t i n g height, body weight, arm and head circumference, and s k i n f o l d thicknesses. Arm muscle dimen-sions are also reported. The children l i v e i n an i n s t i t u -t i o n a l environment; adequate meals are made available on a regular b a s i s . I t was expected therefore that those anthro-pometric parameters sensitive to past n u t r i t i o n a l problems would be affected to a greater extent than those which re-f l e c t current n u t r i t i o n a l status. 29 CHAPTER III MATERIALS AND METHODS A cross-sectional growth study was designed to ob-t a i n information on the growth patterns of Native B r i t i s h Columbian Indian children l i v i n g i n student residences. The objective of the study was to e s t a b l i s h whether the growth patterns of B.C. Native Indian children l i v i n g i n student residences correspond to those of non-Indian re-ference c h i l d r e n . Anthropometric measurements were car-r i e d out on a l l Native Indian children from age 6 to 17 attending the six B.C. student residences administered by the Department of Indian and Northern A f f a i r s . The t o t a l sample size was 368 boys and 366 g i r l s , representing 77 reserves i n the province. The study was c a r r i e d out with the cooperation of Medical Services Branch ( P a c i f i c Region) of the Department of National Health and?: Wei fare, and with the assistance of the administrators of the student r e s i -dences. The student residences were situated i n the follow-ing locations: Sechelt (Sechelt Student Residence), Mission (St. Mary's Student Residence), Kamloops (Kamloops Student Residence), Williams Lake (Cariboo Student Residence), Lejac (Lejac Student Residence) and Lytton (St. George's Student Residence). 30 The name, birthdate and band number.of each c h i l d was obtained from residence records. Table I shows the d i s t r i b u t i o n according to age-sex grouping, as well as the percentage of t o t a l B r i t i s h Columbian Native Indian children i n each age-sex grouping represented i n the study-sample . TABLE I Number of subjects i n each age-sex grouping and as % of t o t a l B.C. Native Indian children i n each group Age Group Females Males Number- %* Number %* 6.00- 6.99 31 4.1 28 3.5 7.00- 7.99 27 3.1 23 2.9 8.00- 8.99 30 3.6 29 3.6 9.00- 9.99 32 4.2 33 4.1 10.00-10.99 30 3.8 38 4.8 11.00-11.99 35 4.5 38 5.4 12.00-12.99 35 5.0 42 6.1 13.00-13.99 42 6.3 37 5.7 14.00-14.99 43 6.9 38 6.5 15.00-15.99 30 5.0 30 4.9 16.00-16.99 30 5.1 32 5.3 Total 366 4.2 368 4.7 * Number i n study sample reported as % of t o t a l number of B.C. Native Indian children i n each eage group. These figures are calculated from data c o l l e c t e d i n 1969. Each percentage i s based upon the t o t a l number of Indian children i n the province for the age group 6 years younger than that of the study sample. A l l anthropometric measurements were done according to the International B i o l o g i c a l Program recommendations (1969). The children were clothed only i n undergarments, and a l l 31 anthropometric measurements were done i n the afternoon, be-fore the evening meal. These included standing height, s i t -t i n g height, body weight, four s k i n f o l d measurements ( t r i -ceps, subscapular, biceps and s u p r a i l i a c ) , midupper arm c i r -cumference and head circumference. Standing height was measured to the nearest 0.1 cm with a portable stadiometer; the measuring board was equipped with a d i g i t a l readout i n order to eliminate parallax. The \"stretching upward\" technique of Tanner and Whitehouse (1966) was not used. S i t t i n g height was s i m i l a r l y measured to the nearest 0.1 cm; a stool of known height was used and actual s i t t i n g height subsequently obtained by subtraction. Body weight was measured to the nearest 0.05 kg with a portable beam-type platform balance. No correction was made for cl o t h i n g . Triceps, subscapular, biceps and s u p r a i l i a c skinfolds were measured with Harpenden Skinfold Calipers (Skin Fold Calipers, Holtain Ltd., Pembrokeshire, Wales), which read to 0.1 mm accuracy. These c a l i p e r s exert a constant pres-2 sure of 10 g/mm through the whole range of s k i n f o l d t h i c k -nesses at a l l distances of jaw separation. This was v e r i -f i e d by the method described by World Health Organization (1968). A l l s k i n f o l d measurements were taken on the l e f t side of the body. The accuracy of the measurements was such that duplicate readings agreed to within - 5% i n two thir d s or more of a l l repeated measurements. The method 32 was validated i n t h i s manner on a group of 12 children, p r i o r to the data c o l l e c t i o n period. Arm circumference was measured to the nearest 0.1 cm, using a st e e l tape measure, with the arm i n a relaxed p o s i -t i o n . Compression of soft tissue was avoided. The measure-ment was taken at the point midway between the acromion pro-cess of the scapula and the olecranon process of the ulna. Upper arm muscle diameter, circumference and area were derived as described by Frisancho (1974), as follows: AC (1) UAMD = ^ - TC (2) UAMC = AC - 77\" TC (3) UAMA = [UAMD2] where UAMD = upper arm muscle diameter (mm) UAMC = upper arm muscle circumference (mm) UAMA == upper arm muscle area (mm ) TC = tr i c e p s s k i n f o l d thickness (mm) AC = arm circumference (mm) Head circumference was measured by placing the tape firmly around the f r o n t a l bones, just superior to the supra-o r b i t a l ridges, passing i t around the head at the same l e v e l on each side, and over the maximum o c c i p i t a l prominence at the back. Data were recorded on the \" N u t r i t i o n a l Status I n v e s t i -gation Form\" of the School of Home Economics. The coded sheets were read by the IBM 1232 Optical Mark reader at Simon Fraser University and key punched onto cards. The 33 data were then treated by a u t i l i t y computer program and preliminary scatter p l o t s of selected variables were made to a s s i s t i n the detection of obvious err o r s . Data analysis was c a r r i e d out with the IBM 370/168 computer. Scatter d i a -grams of i n d i v i d u a l findings were prepared with the CALCOMP p l o t t e r together with standard reference curves. 34 CHAPTER TV RESULTS A l l anthropometric parameters are displayed graphi-c a l l y (pages 45 to 64), against chronological age, with the exception of biceps and s u p r a i l i a c skinfold thickness. These two parameters, as well as s i t t i n g height/standing height r a t i o , are l i s t e d i n the Appendix. 1. Standing Height. Figures 1-1 and 3>2 show stand-ing heights for males and females, respectively. Standard curves are those of Jackson and Kelly (1945), derived from the Iowa growth data, measurements taken several decades ago on Caucasian children predominantly from the higher socioeconomic group. In using standards derived from a group both c u l t u r a l l y and genetically d i s t i n c t from the study sample., i t i s recognized that interpretation of re-su l t s i s somewhat lim i t e d . Standard curves therefore are presented as a reference only. Throughout the age range studied, most individuals f a l l between the mean and 2 standard deviations below the mean. In males, 79V percent of the study sample f a l l i n t h i s range. Eleven percent are above the mean. While none are more than 2 standard deviations above the mean, 10 percent 35 of males are more than 2 standard deviations below the mean. Those more than 2 standard deviations below the mean are not evenly d i s t r i b u t e d throughout the age range studied for males between 6 and 8 years old, 23 percent are more than 2 standard deviations below the mean, while for older males, between 14 and 16 years, t h i s percentage has decreased to 8.8. In females, 70 percent of a l l indiv i d u a l s are bet-ween the mean and 2 standard deviations below the mean. Twenty-five percent of females are above the mean. While none are more than 2 standard deviations above the mean, 5 percent of females are more than 2 standard deviations be-low the mean. Of the females between 6 and 8 years o l d , 15.5 percent are more than 2 standard deviations below the mean while for older females between 14 and 16 years t h i s percentage has decreased to 3 percent. Thus the proportion of females who have low height for age, as compared with r e-ference children, decreases with increasing age^ as with males. 2. S i t t i n g height.\" As previously mentioned, s i t t i n g height/standing height r a t i o was computed; i n d i v i d u a l f i n d -ings are l i s t e d i n the Appendix since standards are not available for t h i s parameter. Only s i t t i n g height i s d i s -played graphically (Figures I I - l and II-2). The standards of Simmons (1944) are used (mean - 2 standard deviations). 36 These standards are based upon measurements taken several decades ago on Caucasian c h i l d r e n . This parameter indicates growth of the head and trunk. In general, the pattern of s i t t i n g height i s similar to that of standing height. In both males and females, most ind i v i d u a l s f a l l between the mean and 2 standard deviations below thermean. Among males, 66 percent are i n t h i s range. Only 12 percent are above the mean. While none are more than 2 standard deviations above the mean, 22 percent of males are more than 2 standard deviations below the mean. For those males between 6 and 8 years o l d , 60 percent are more than 2 standard deviations below the mean. However, for older males, between 14 and 16 years, t h i s percentage decreases to 0.8 percent. Among females, 66 percent of a l l i n d i v i d u a l s are bet-ween the mean and 2 standard deviations below the mean. Ten percent of females are above the mean. While none are more than 2 standard deviations above the mean, 24 percent of females are more than 2 standard deviations below the mean. For those females between 6 and 8 years old, 40 percent f a l l more than 2 standard deviations below the mean. Among older females, between 14 and 16 years, t h i s percentage decreases to 27 percent. Thus, for both sexes, the proportion of children with a d e f i c i t i n s i t t i n g height decreases with i n -creasing age. 37 3. Body weight. Figures I I I - l and III-2 show body weight plotted against chronological age. Standard curves are those of Jackson and K e l l y (1945). Mean, 3rd and 97th percentiles are presented. Most in d i v i d u a l s are between the 3rd and 97th percentiles, although for both males and females, the majority are between the mean and 3rd percen-t i l e . Thus, 79 percent and 78 percent of males and females respectively are between the mean and the 3rd p e r c e n t i l e . Among males, 18 percent are above the mean for body weight, including one i n d i v i d u a l (less than 1 percent of a l l males) above the 97th p e r c e n t i l e . Three percent of males are below the 3rd pe r c e n t i l e . Among females, 21 per-cent are above the mean, including one i n d i v i d u a l (less than 1 percent of a l l females) above the 97th p e r c e n t i l e . One percent of females are below the 3rd p e r c e n t i l e . These r e s u l t s are i n t e r e s t i n g i n view of the large proportion of children of both sexes who show d e f i c i t s i n standing and s i t t i n g height. i \u00E2\u0080\u00A2 . 1 4. Skinfold thickness. Figures IV-1 to IV-4 d i s -'.j play t r i c e p s and subscapular s k i n f o l d thicknesses for males and females. Percentile curves are those of Tanner and Whitehouse (1975), and are derived from cross-sectional data on London school children taken i n 1966. These per c e n t i l e curves have been smoothed grap h i c a l l y . Since values ob-tained by s k i n f o l d measurements give a non-gaussian f r e -quency d i s t r i b u t i o n , the appropriate logarithmic transforma-t i o n , as described by these authors has been employed for j 38 both skinfolds, and transformed values plotted against age. Males are predominantly below the 50th percentile at a l l ages for t r i c e p s s k i n f o l d thickness. Eighteen percent i of males are above the 50th percentile and t h i s generally follows the preadolescent f a t wave: slow apposition, f o l -lowed around age 13 by a s l i g h t decrease i n thickness as described by Garn and Haskell (1960). Tanner and White-house (1975) consider those i n d i v i d u a l s below the 3rd per-c e n t i l e to be at r i s k , being perhaps undernourished. Sev-e r a l males i n t h i s study sample are considerably below that p e r c e n t i l e , while none exceed the 97th p e r c e n t i l e . Triceps s k i n f o l d thickness i n females (Figure IV-2) i s generally below the 75th percentile of Tanner and White-house. More females than males are below the 3rd percentile (9.5 percent of' females compared to 4 percent of males), however sim i l a r proportions are above the 75th percentile (2 percent of females compared to 3.5 percent of males). No females reach the 90th p e r c e n t i l e . The general trend of gain i n adiposity over the age range studied adheres to that of the reference curves: increased t r i c e p s subcutan-eous fat with age, which continues (unlike that of males) throughout childhood and into adolescence. Figure IV-3 depicts subscapular s k i n f o l d thickness of males. Most in d i v i d u a l s (92 percent) are between the 10th and 75th p e r c e n t i l e s . No males studied are at the upper extreme for subscapular s k i n f o l d thickness and only 39 two in d i v i d u a l s are below the 3rd p e r c e n t i l e . The trend of increase i n subscapular adipose tissue with age, as i n -dicated by standard percentile curves, i s seen i n the study sample. Subscapular fat apposition, unlike that i n the t r i -ceps region, continues to increase through adolescence i n males. Figure IV-4 shows subscapular s k i n f o l d thickness of females. Eighty-two percent of females are between the 10th and 75th p e r c e n t i l e . More females than males appear i n the extreme lower percentile range: 11 percent of f e -males are below the 10th percentile compared with 3.5 per-cent of males. Tanner and Whitehouse (1975) consider those ind i v i d u a l s at the 97th percentile to be obese. Only one female i n t h i s study can be so considered on that basis. For females, i t i s c l e a r that increase i n subscapu-l a r adipose tissue follows that indicated by the standard curves, with a gradual increase i n thickness from c h i l d -hood into adolescence. Throughout t h i s period of growth, females have greater subscapular fat than do males, as the standard curves ind i c a t e . 5. Arm circumference. Figures V - l and V-2 show arm circumference measurements of males and females respectively. Standard percentile curves are those of Frisancho (1974), and are based on a cross-sectional sample of white subjects f .\u00E2\u0080\u00A2\u00E2\u0080\u00A2(' derived from the United States Ten State N u t r i t i o n Survey of 1968-19,70. These standard curves are from measurements 40 taken on the right arm. As can be seen from Figure V - l , most males (82 per-cent) have arm circumferences that are between the 15th and 85th p e r c e n t i l e . Only 2 percent of indiv i d u a l s are above the 85th p e r c e n t i l e , while 16 percent are below the 15th p e r c e n t i l e . Arm circumference i n the group as a whole i s seen to increase throughout the age-range studied,despite the decrease i n t r i c e p s s k i n f o l d thickness beginning at age 12. Individual findings for females (Figure V-2) have a very similar d i s t r i b u t i o n across standard percentile curves to males, with the study sample as a whole weighted toward the lower p e r c e n t i l e s . Eighty percent of females have arm circumferences between the 15th and 85th p e r c e n t i l e . Only 3 percent of females are above the 85th p e r c e n t i l e , while 17 percent are below the 15th p e r c e n t i l e . Increase i n arm circumference occurs at a s l i g h t l y slower rate i n females than i n males, as the standard curves show. However, at age 14 the rate of increase i s decelerated i n females while male arm circumference con-tinues to increase with age. 6. Upper arm muscle diameter. Figures VI-1 and VI-2 show upper arm muscle diameter measurements, derived as described e a r l i e r , together with the standard percentile curves of Frisancho (1974). Eighty-five percent of males 41 are between the 15th and 85th percentiles, i n d i c a t i n g that arm muscle diameter i s well maintained i n the study sample as a whole. This parameter c l o s e l y approximates that of the reference group and increases throughout the age range studied. Arm circumference and t r i c e p s s k i n f o l d thickness, as described e a r l i e r , are weighted toward the lower percen-t i l e curves. I t seems apparent, therefore, that the i n -crease i n arm circumference with age i s due primarily to growth i n muscle t i s s u e . Eighty-three percent of upper arm muscle diameter measurements of females (Figure VI-2) are between the 15th and the, 85th p e r c e n t i l e . This group, as a whole, i s weighted toward the upper percentile curves: 15'percent of females f are above the 85th percentile while 2 percent are below the 15th. For males, these proportions are 5 percent and 8 per-cent respectively. No female i n the study i s below the 5th p e r c e n t i l e . This i s notable i n the l i g h t of arm circum-ference and t r i c e p s s k i n f o l d which are weighted towards the lower p e r c e n t i l e . Thus, upper arm musculature i s well main-tained despite generally lesser increases i n upper arm a d i -pose t i s s u e . Rate of increase i n upper arm muscle diameter i s slower i n females than i n males. A plateau i s achieved at age 15 i n females, while i n males t h i s measurement continues to increase throughout adolescence. 42 7. Upper arm muscle circumference. Figures VI-3 and VI-4 show upper arm muscle circumference of males and females respectively, together with the percentile curves of Frisancho (1974). The d i s t r i b u t i o n of i n d i v i d u a l values across standard percentile curves, as well as the general pattern of muscle growth with age i s sim i l a r to that of upper arm muscle diameter for both sexes. 8. Upper arm muscle area. Figures VI-5 and VI-6 display upper arm muscle area of males and females respec-t i v e l y . Males are predominantly between the 15th and 85th percentiles (88 percent are i n t h i s range), being well d i s -tributed about the mean (6 percent of males are above the 85th pe r c e n t i l e , and 6 percent are below the 15th percen-t i l e ) . Increase i n t h i s dimension with age continues throughout the age range studied. This trend i s not no-ticeable when muscle size i s expressed i n terms of diameter or circumference. Upper arm muscle area measurements i n females ( F i -gure VI-6) are predominantly between the 15th and 85th percentile (82 percent of a l l females are i n t h i s range), with more values above the 85th percentile than below the 15th (16 percent and 2 percent r e s p e c t i v e l y ) . Growth i n t h i s dimension occurs into adolescence, however i t i s slowed a f t e r age 12. Thus, i t i s at t h i s age when the greatest differences i n upper arm muscle area between males and females occur. 43 9. Head circumference. Head circumference measure-ments are reported i n Figures VII-1 and VII-2 of males and females respectively. The re s u l t s are plotted against the standard curves of Watson and Lowry (1967). These standards present the mean i 2 standard deviations and are not sex-s p e c i f i c . They are derived from measurements on Caucasian c h i l d r e n . Most males are within - 2 standard deviations.of the mean; only 8 percent are outside these l i m i t s . As age i n -creases more ind i v i d u a l s are above the mean. Thus, i n males between 6 and 8 years, 25 percent are above the mean while 75 percent are below the mean. For older children between 14 and 16 years, these percentages are 82 and 18 percent re spectively. Females display a similar growth pattern i n head c i r -cumference. Most females are within - 2 standard deviations of the mean; only 6 percent are outside these l i m i t s . A sim i l a r pattern also i s noted with increasing age as with males. In females, between 6 and 8 years 1 percent are above the mean while 99 percent are below the mean. Bet-ween 14 and 16 years these percentages are 32 percent and 68 percent respectively. In summary, a growth l a g i s observed i n standing and s i t t i n g height i n both sexes, which i s p a r t i a l l y corrected during adolescence. This i s apparent since there i s a de-crease i n proportion of children more than 2 standard devia-tions below the mean as age increases. Body weight measurements 44 more c l o s e l y approximate standards than do standing and s i t t i n g height. The d e f i c i t i n stature i s therefore not re f l e c t e d by a similar d e f i c i t i n body weight. Growth pat-terns i n arm circumference follow the expected trends i n both sexes, although\"individual findings as a whole are weighted below the'smean. Triceps s k i n f o l d measurements indicate l e s s subcutaneous adipose tiss u e than expected when compared with those of reference c h i l d r e n . Arm muscle diameter, circumference and area approximate standard curves. Subscapular skinfolds generally approximate standards more c l o s e l y than do t r i c e p s with fewer in d i v i d u a l s below* the 3rd per c e n t i l e , for both sexes. As expected, le s s a d i -pose tissue i s found at t h i s s i t e , although increase with age continues into adolescence. Head circumference measure-ments for both sexes display a growth trend si m i l a r to that of standing and s i t t i n g height. An i n i t i a l d e f i c i t i s ob-served, as compared to standards, with large proportions of both males and females below the mean of reference c h i l d r e n . This i s l a r g e l y corrected during adolescence, an e f f e c t more d i s t i n c t i n females than i n males. 45 Figure 1-1. Standing height of males. low.a standard curves are displayed as the mean + 2 standard deviations (Jackson and K e l l y , 1945). 46 Figure 1-2. Standing height of females. Iowa standard curves are displayed as the mean + 2 standard deviations (Jackson and K e l l y , 1945). 47 Figure I I - l . ' S i t t i n g height of males. Standard curves are displayed as the mean + 2 standard d e v i a t i o n s (Simmons, 1944). Figure II-2. S i t t i n g height of females, ard curves are d i s p l a y e d as the mean + 2 d e v i a t i o n s (Simmons, 1944). Stand-t t a n d a i l 49 Figure I I I - l . Weight of males. Iowa standard curves are displayed as the 3rd, 50th and 97th p e r c e n t i l e s (Jackson and K e l l y , 1945). 50 Figure III-2. Weight of females. Iowa standard curves are displayed as the 3rd, 50th and 97th p e r c e n t i l e s (Jackson and K e l l y , 1945). 51 Figure IV-2. Triceps: s k i n f o l d thickness of females. Standard p e r c e n t i l e curves are from Tanner and Whitehouse (1975). Figure IV-3. Subscapular s k i n f o l d thickness of males. Standard p e r c e n t i l e curves are from Tanner and White-house (197 5). 54 0.0 2.0 I \u00E2\u0080\u0094 4.0 6.0 8.0 AGES 1 \u00E2\u0080\u0094 10.0 (YR) ~ 1 \u00E2\u0080\u0094 12.0 \u00E2\u0080\u00941 M.O 16.0 \"I 18.0 I 20.0 Figure IV-4. Subscapular s k i n f o l d thickness of females. Standard p e r c e n t i l e curves are from Tanner and Whitehouse (1975). 55 Figure V - l . Arm circumference of males. Standard p e r c e n t i l e curves are from Frisancho (1974). 56 1 1 1 1 1 1 1 1 1 i 0.0 2.0 4.0 6.0 8.3 10.0 12.0 14.0 16.0 18.0 20. AGES IYR) Figure V-2. Arm circumference of females. Standard p e r c e n t i l e curves are from Frisancho (1974). 95 4.C I \u00E2\u0080\u0094 6.0 _, , e.c io.o RGES CYR) 12.0 \"T 14.0 16.0 10.0 \u00E2\u0080\u0094 I 20 Figure VI-1. Upper arm muscle diameter of males. Standard p e r c e n t i l e curves are from Frisancho (1974). 58 o o . !' H Q Hi O W I \u00C2\u00A7 5 J ~ i \u00E2\u0080\u0094 6.0 - 1 \u00E2\u0080\u0094 8.0 I 14.0 I 20.0 0.0 2.0 4.0 10.0 IYR] I 12.0 16.0 18.0 Figure VI-2. Upper arm muscle diameter of females. Standard p e r c e n t i l e curves are from Frisancho (1974). -i 1 : 1 1 1 1 r r 1 1 1 0.0 2.0 4.0 6.0 8.0 10.0 12.0 H.O 16.0 18.0 20 AGES (YR) Figure VI-3. Upper arm muscle circumference of males. Standard p e r c e n t i l e curves are from Frisancho (1974). 60 o o ~ 1 \u00E2\u0080\u0094 A.a \u00E2\u0080\u0094 i \u00E2\u0080\u0094 6.0 \u00E2\u0080\u0094 1 8.0 RGES - i \u00E2\u0080\u0094 14.0 \u00E2\u0080\u0094I 16.0 TaTo - 1 20.0 0.0 2.0 10.0 (YR) 12.0 Figure VI-4. Upper Standard p e r c e n t i l e arm muscle circumference of females, curves are from Frisancho (1974). 61 Figure VI-5. Upper arm muscle area of males. Standard p e r c e n t i l e curves are from Frisancho (1974). 62 Figure VII-1. Head Standard curves are standard d e v i a t i o n s circumference of males, displayed as the mean + 2 (Watson and Lowry, 1967). Figure VII-2. Head circumference of females. Standard curves are displayed as the mean + 2 standard d e v i a t i o n s (Watson and Lowry, 1967). 65 CHAPTER V DISCUSSION The use of anthropometric data for the assessment of n u t r i t i o n a l status i s constrained by the well recognized fact that many factors, both environmental and genetic, af-fect the rate, p o t e n t i a l and pattern of growth. Therefore, deviations from standard may be due to one or more causes or to a more complex i n t e r a c t i o n of several. In in t e r p r e t -ing growth data i n n u t r i t i o n a l terms without information r e-garding actual nutrient intakes, one i s hesitant i n assign-ing c e r t a i n observations to n u t r i t i o n a l causes, except by reference to other studies. The objective of the study, as stated e a r l i e r , was to e s t a b l i s h whether the growth patterns of B r i t i s h Columbia Native Indian children l i v i n g i n student residences corres-pond to those of non-Indian reference children. The study was cross-sectional i n nature; anthropometric data were gathered using a d i f f e r e n t sample of indivi d u a l s at each point within the age range studied. I m p l i c i t i n t h i s de-sign are c e r t a i n r e s t r i c t i o n s i n the inter p r e t a t i o n of data on the basis of growth patterns. In a cross-sectional study, one i s ac t u a l l y assessing 66 the body size of children at various ages rather than the patterns of change i n body size and dimension of a single sample of children followed through time (longitudinal study) Any anthropometric parameter r e f l e c t s to a;greater or lesser degree, c e r t a i n genetic and environmental (including n u t r i -tional) factors a f f e c t i n g an i n d i v i d u a l ' s growth. However, conclusions cannot j u s t i f i a b l y be drawn on the patterns of growth of an i n d i v i d u a l or group on the basis of measure-ments taken on independent samples. Thus, although the cross sectional growth study i s of value i n assessing various para-meters of body size and dimension of children at d i f f e r e n t ages during t h e i r growing period, the actual process of growth i s not evaluated. The longitudinal study i s more amenable to such interp r e t a t i o n , allowing conclusions to,->be drawn on the rate and v e l o c i t y of growth as well as catch-up growth. Longitudinal studies have the major disadvantage of a considerable time requirement for data c o l l e c t i o n . There are other well-recognized shortcomings of cross-sectional data analysis. As described by Prahl-Anderson and Kowalski (1973), the chronological age variable i s confounded with the cohort variable i n cross-sectional studies. With reference to the present study, differences observed, for example, i n standing height between 6 year o l d males and 16 year old males r e f l e c t age changes as well as d i s s i m i l a r i t i e s i n environmental and c u l t u r a l pressures. These authors suggest that the repeated findings of substantii discrepancies between inferences made on the basis of cross-sectional and longitudinal data for anthropometric v a r i -ables (Damon, 1965) point to the important role the cohort e f f e c t may play. Baltes (1968) has stated that both cross-sectional and lo n g i t u d i n a l designs have such an absence of control as to be of very l i t t l e s c i e n t i f i c value. In view of the disadvantages of both cross-sectional and longitud-i n a l designs to the study of growth and development, Prahl-Anderson and Kowalski (1973) have described a mixed-longitudinal type with overlapping cohorts, as a convenient compromise. However, i t s a p p l i c a b i l i t y and usefulness i n the assessment of populations has not yet been explored. Despite the l i m i t a t i o n s of the cross-sectional de-sign and of int e r p r e t a t i o n of cross-sectional data, useful information on the growth status of children i s available with t h i s approach. In the present study, a d e f i c i t i n standing height i s demonstrated by the large percentage, i n both sexes, f a l l -ing below the Iowa mean (89 percent and 75 percent respec-t i v e l y for males and females). The decrease i n the percent-age with heights more than 2 standard deviations below the mean during childhood as compared with l a t e r adolescence, for both sexes, i s similar to that reported by Lee et a l . (1971) for childr e n from the Anaham and Ahousat Reserves. The authors suggest that a catch-up e f f e c t i s observed, i n that rate of growth i s increased aft e r the i n i t i a l d e f i c i t , 68 providing some compensation. This i s uncertain, however, since t h e i r data were cro s s - s e c t i o n a l . Reisinger et a l . (1972) reported si m i l a r findings among Navajo Indian children between 5 and 14 years from the Lower Greasewood Reserve i n Arizona. In that study 83 percent of males and 81 percent of females were below the 50th percentile for height of Iowa reference c h i l d r e n . In males, the percentage below the 3rd percentile decreased from 19 percent for those between 5 and 9 years to 10 per-cent for those between 10 and 14 years. The authors do not comment on the s t a t i s t i c a l significance of t h i s f i n d i n g . A simi l a r decrease was not observed among females. The authors suggest that t h i s may represent catch-up growth. Diet evalua-tions i n that study suggest that many of the study subjects had inadequate food intakes which could account for the growth retardation. Height measurements reported by Darby et. a l . (1955) on Navajo children, i n comparison with Canadian data, re-veal Navajo children to be shorter than Canadians a f t e r age 10. The authors comment that since 1910 various influences (including nutrition) have resulted i n t a l l e r Canadians, but that these influences are not noticeable among the Navajo. The study on preschool Navajo children of Van Duzen et a l . (1969), reported nearly one-third of the sample be-low the 3rd percentile of Iowa standards for height. The authors suggested that the observed retardation i n growth 69 was caused by chronic c a l o r i e and protein malnutrition as wel l as c e r t a i n disease factors. In contrast to these findings, both ICNND studies (1964, 1964) c a r r i e d out i n the U.S. (on Native Indian c h i l d -ren of the Fort Belknap and Blackfoot Reservations) ..report average standing heights almost e n t i r e l y at or above Iowa means for both sexes. Growth i n head and trunk i s observed as increase i n s i t t i n g height with increasing age. Although the same ten-dencies toward a decreased percentage of ind i v i d u a l s below 2 standard deviations, with age, i s noticeable i n t h i s para-meter, as with standing height, conclusions drawn regarding body proportion and r e l a t i v e contribution of head and trunk to standing height are not j u s t i f i e d . For t h i s purpose, s i t t i n g height/standing height r a t i o should be analyzed. From the data, i t i s clear that s i t t i n g height i n most children i s less than expected when compared with standards. Thus 88 percent of males and 90 percent of females are be-low the mean of reference c h i l d r e n . Similar findings were reported i n B r i t i s h Columbian Indian children by Birkbeck et a l . (1971). Although these two parameters, standing and s i t t i n g height, indicate a growth lag i n the study sample as a whole, a comparable d e f i c i t i s not seen i n body weight mea-surements. As described e a r l i e r , males and females f a l l l a r g e l y within the two extremes of Iowa standards, and i n -crease i n body weight with age follows normal pattern. Thus, 70 body weight i s generally adequate despite short stature. Body weight i s more vulnerable to immediate n u t r i -t i o n a l i n s u l t , and i s more adversely affected during times of n u t r i t i o n a l deprivation than are some other parameters. However, attained body stature i s r e f l e c t i v e of past growth rate; i t i s a cumulative index of growth. Therefore, the p o s s i b i l i t y that the observed lag i n st a t u r a l growth has a n u t r i t i o n a l basis i s open. A l l children i n the study sample were residing i n student residences where adequate n u t r i t i o n was made ava i l a b l e . The i n s t i t u t i o n a l setting could well provide the opportunity for d e f i c i t s i n weight to be correc-ted, through proper n u t r i t i o n while the d e f i c i t i n stature would not be so immediately affected. Dietary data on B.C. Native Indians suggests that the intakes of c e r t a i n nutrients i s below optimal for c h i l d -ren. Data c o l l e c t e d by 24-hour r e c a l l on the Anaham Reserve by Lee et ad.. (1971) showed that a number of childr e n had intakes of c a l o r i e s , calcium and vitamin A less than two thir d s of the Canadian Dietary Standards. In addition, a number of teenagers, of both sexes, had low i r o n intakes. Of the present study sample, 61 children measured, repre-senting 8 percent of t o t a l , were from the Anaham Reserve; t h i s i s the largest number of children from a single reserve. The seven reserves located i n B.C. surveyed by N u t r i t i o n Canada (1973) (results of which are discussed i n the Intro-duction) contributed 46 children to the present study, re-presenting 6 percent of the total*sample. N u t r i t i o n Canada 71 documented poorer n u t r i t i o n a l status of the Canadian Indian population as compared to the general population. Although figures are not presented, most older c h i l d -ren had attended residences for several years and have been afforded adequate n u t r i t i o n for a greater proportion of time than have younger children who show greatest d e f i c i t s i n stature. Thus, the p o s s i b i l i t y f or a catch-up phase subse-quent to the l a g i n growth i s present. In a sim i l a r study, ca r r i e d out among extremely poor children i n Peru by Andrianzen et a_l. (1973) found a s i g n i -f i c a n t l a g i n l i n e a r growth while body weight as a whole was much les s severely affected. The authors postulate that these children experienced periods of recovery from malnu-t r i t i o n with easy weight gain but incomplete return to nor-mal of the mechanisms necessary for l i n e a r growth. Although i t i s not l i k e l y that children of the present study sample have undergone severe n u t r i t i o n a l i n s u l t , a sim i l a r s i t u a -t i o n could be present. He l l e r et a l . (1967) observed height d e f i c i t s coin-cident with adequate body weight (as compared with Iowa data) i n Alaskan Eskimo preschoolers. The authors state that these patterns could be explained by inherited factors or by persistent environmental influences, although they f e l t that a n u t r i t i o n a l explanation was u n l i k e l y . This sample was re-examined several years l a t e r and a cross-tabulation of the measurements of the o r i g i n a l cohort of children during t h e i r f i r s t two years of l i f e , as proposed by Waterlow (1972), was c a r r i e d out by Nichaman et a l . (1975). I t was shown that the occurrence of moderate and severe growth retardation was at least s i x times more pre-valent than acute under n u t r i t i o n . I t i s possible that Native Indian children are of shorter stature, and of r e l a t i v e l y greater body weight than Caucasians, as a r e s u l t of genetic f a c t o r s . However, Ha-bicht et a l . (1974) have shown that the genetic e f f e c t of mean growth i n height and weight i n children i s small com-pared with environmental e f f e c t s . Thus, 3 percent of d i f -ferences i n height and 6 percent of differences i n weight were attributable to differences i n ethnic background. The importance of t h i s study i s that the authors have c o l l e c t e d a wider range of information and made s c i e n t i f i c compari-sons more pr e c i s e l y than heretofore. Imp l i c i t i n these re-sults i s the suggestion that one set of growth standards should be appropriate for evaluation of data from a l l eth-nic groups. J e l l i f f e and J e l l i f f e (1975) point out the d i f f i c u l -t i e s i n selection of standards for universal use; p r i m a r i l y due to problems i n delineating the genetic \"mainstream of mankind\". Thus, for example, i t seems unl i k e l y that o p t i -mally fed infants belonging to a gen e t i c a l l y short group would achieve the \"universal standard\". However, growth data on Japanese children (Takahashi, 1966) shows that \u00E2\u0082\u00AChis group i s now heavier and t a l l e r than previous genera-t i o n s , approximating the Western overfed model. I t i s un-clear which standards represent the optimum as regards pre-sent and future health and s u r v i v a l and which represent the overnourished with p o t e n t i a l or actual r i s k s of obesity. Garn (1965), however, suggests that differences i n stature as well as body b u i l d and f a t - f r e e mass:.:complicate the universal application of simple standards of height and weight. This author advocates the use of parent-specific or parent-corrected size standards for growing c h i l d r e n . Fur-ther, i t i s suggested that reference standards should be ap-propriate to the population i n question, making use of the economically advantaged group to provide an i n d i c a t i o n of optimum growth. In a more recent report Garn and Clark (1975) out-l i n e the problems i n the n u t r i t i o n a l assessment of black i n d i v i d u a l s , when compared with standards of white r e f e r -ence children, due to consistent differences i n standing height, and body weight as well as s k e l e t a l mass and bone density. They conclude that f a i l u r e to employ appropriate standards w i l l r e s u l t i n underestimating the dimensional, radiographic and radiogrammetric e f f e c t s of undernutrition i n blacks a f t e r the second year of l i f e . Their conclusions are based on data from several large-scale n u t r i t i o n and growth studies,.including the Preschool N u t r i t i o n Survey (Owen et a l . , 1974), the National Collaborative Survey (Garn et a l . / 1974), the Ten-State N u t r i t i o n Survey (Garn et a l . , 1973), Kaiser-Permanente Survey (Winegerd et a l . , 74 1973) andthe National Health Examination Survey (Hamill et a l . , 1970). Although i t i s plausible that a similar case could be made for the inter p r e t a t i o n of Native Indian data, suf-f i c i e n t information i s simply not av a i l a b l e . By and large, r e l a t i v e l y few studies have been c a r r i e d out on North Amer-ican Indian children, as discussed e a r l i e r . So that while comparison of present data with that of reference children, both c u l t u r a l l y and gene t i c a l l y d i s t i n c t , might be inappro-pr i a t e for correct int e r p r e t a t i o n , more suitable standards are not a v a i l a b l e . Coincident with the observed s t a t u r a l growth l a g and r e l a t i v e l y adequate body weight increase with age, the re s u l t s show a tendency toward le s s subcutaneous adipose tissue than expected on the basis of comparison with the standards of Tanner and Whitehouse (1975). Thus, 82 per-cent of males and 87 percent of females are below the 50th percentile for t r i c e p t s s k i n f o l d thickness; i n addition 68 percent of males and 65 percent of females are below the 50th percentile for subscapular s k i n f o l d thickness. Tanner and Whitehouse state that the percentiles reported as stan-dards imply nothing as to the d e s i r a b i l i t y or u n d e s i r a b i l i t y of a group or population having a sim i l a r d i s t r i b u t i o n of subcutaneous f a t . Racial differences i n amount and d i s t r i b u t i o n of body f at have been observed. Malina (1966) has shown that black American c h i l d r e n have c o n s i s t e n t l y l e s s t r i c e p s and subscapular adipose t i s s u e than do white c h i l d r e n . Robson et a l . (1971) r e p o r t s t h a t the r a t i o of t r i c e p s s k i n f o l d t o subscapular s k i n f o l d t hickness mainly i n black i n f a n t s and c h i l d r e n from Dominica was s u b s t a n t i a l l y l e s s than t h a t of white c h i l d r e n from B r i t a i n . A s h c r o f t (1972) argues t h a t i t i s necessary t o measure other s k i n f o l d s i n order t o estimate body f a t adequately and t o make assumptions r e l a t i v e t o d i e t -ary adequacy. Mean s k i n f o l d thicknesses of c h i l d r e n i n developing c o u n t r i e s are g e n e r a l l y found t o be smaller than those of c h i l d r e n i n developed c o u n t r i e s , an e f f e c t which.is i n p a r t due t o d i f f e r e n c e s i n n u t r i t i o n a l s t a t u s . Thus Malina et a l . (1974) r e p o r t s t h a t mean s k i n f o l d t hickness of r u r a l Guatemalan Ladino c h i l d r e n are low when compared w i t h the standards of Tanner and Whitehouse (1962). They are l i k e -wise smaller than those of urban c h i l d r e n i n upper socio--economic s t r a t a of developing c o u n t r i e s (Mora P a r r a et a l . , 1970). I n t e r e s t i n g l y , the Guatemalan data shows a l a r g e r d e f i c i t i n t r i c e p s s k i n f o l d than i n subscapular s k i n f o l d as does the present data. Thus, mean values f o r t r i c e p s are at or below the 10th p e r c e n t i l e of standard between 6 months and 7 years, while mean values f o r subscapular, dur-i n g t h a t age range, vary between the 25th and 50th percen-t i l e . The authors s t a t e t h a t d i f f e r e n t i a l f a t r e d u c t i o n 76 on the extremities and trunk i n marginal n u t r i t i o n a l status may be implied. In n u t r i t i o n a l terms, le s s body f a t , as r e f l e c t e d by le s s subcutaneous adipose t i s s u e , means a smaller c a l o r i e reserve available to the i n d i v i d u a l . Tanner and Whitehouse regard children at either extreme to be at r i s k . In the present study sample, 9.5 percent of females and 4 percent of males would be considered undernourished, by the c r i t e r i a of these authors. However, since other body measurements were not correlated with t r i c e p s skinfolds i n these p a r t i -cular c h i l d r e n and since dietary h i s t o r i e s are not a v a i l -able, one i s hesitant to draw conclusions regarding t h e i r n u t r i t i o n a l status. Whether the generally lower degree of subcutaneous adipose tissue i n B.C. Native Indian children l i v i n g i n residence i s due to ethnic o r i g i n , to cer t a i n environmental factors or s p e c i f i c a l l y to n u t r i t i o n a l causes, i s unclear. Upper arm muscle i n both sexes was observed to be well maintained; i t i s growth of t h i s tissue mass which makes the greatest contribution toward o v e r a l l increase i n arm circumference. Similar findings were reported by Gurney et a l . (1972) among Jamaican infants and preschool c h i l d r e n . Eight percent had arm circumferences below the 3rd percen-t i l e while 21.4 percent had t r i c e p s s k i n f o l d thicknesses which were below t h i s percentile of standard values. The 77 authors concluded that t h e i r d i e t may be lacking i n t o t a l c a l o r i e s rather than i n protein. Martorell et. aJL. (1976), who reported findings on a group of r u r a l Guatemalan preschool children, drew si m i l a r conclusions. I t was found that although these children had a reduced arm muscle and fat area, the r e l a t i v e reduction i n arm fat area was greater than i n arm muscle area. Compari-son was made with the standards of Frisancho (1974). I t was suggested that lack of energy rather than protein d e f i -ciency i s the main n u t r i t i o n a l problem i n t h i s group. I t i s tempting to assign the present observations to similar dietary patterns, although both of the above studies were c a r r i e d out on preschool c h i l d r e n . Indeed, N u t r i t i o n Canada Survey (1973) reported that c a l o r i c intakes of adole-scent Indians were consistently lower than those of the adolescents of the national population, while protein i n -takes for t h i s group were more than adequate. Very few i n -dividuals were c l a s s i f i e d as at r i s k on the basis of serum protein values. However, the present study sample may be l a r g e l y removed from these dietary patterns. One i s j u s t i -f i e d i n concluding from these data, however, that protein n u t r i t i o n a l status of B.C. Indian children l i v i n g i n r e s i -dences may be r e l a t i v e l y better than c a l o r i e n u t r i t i o n a l status. Although the e f f e c t s of n u t r i t i o n a l status upon growth i n head circumference are seen predominantly i n early childhood, 78 these e f f e c t s may be r e f l e c t e d by subsequent growth pattern. Thus, as shown by Malina (1975), smaller mean head circum-ferences i n l a t e r childhood apparently r e f l e c t growth r e -tardation during the f i r s t two years of l i f e . Most rapid growth i n head circumference occurs during early infancy with a substantial decrease i n v e l o c i t y by age 6. Thus the magnitude of change i n head circumference over the age-range studied i s not great. However, those children who f a l l at or below the lower extremes may have experienced some nu-t r i t i o n a l i n s u l t i n the past. Thus, i t i s d i f f i c u l t to ascribe a catch-up growth e f f e c t to the observed improvement with age i n head circum-ference r e l a t i v e to standard. Similar r e s u l t s were obtained by Birkbeck et a l . (1972) on Native Indians from the Anaham and Ahousat reserves. I t i s i n t e r e s t i n g to note that a l -though there i s an increasing ..dissociation between head circumference and stature as children grow older (Malina et a l . , 1975), the pattern of growth i n t h i s measurement i n the present study i s very similar to that of growth i n stand-ing height. 79 CHAPTER VI SUMMARY AND RECOMMENDATIONS Summary Growth patterns of B r i t i s h Columbian Native Indian children l i v i n g i n student residences were studied u t i l i z -ing n u t r i t i o n a l anthropometric techniques on 734 children aged 6 to 17 years attending six student residences. The study was cross-sectional i n design and r e s u l t s were com-pared with standard reference data. The objective of the study was to es t a b l i s h whether the growth pattern of B.C. Native Indian children l i v i n g i n student residences cor-respond to those of non-Indian reference c h i l d r e n . A considerable growth d e f i c i t was demonstrated i n younger children which appears to be somewhat corrected by adolescence. The study sample as a whole are short when compared with Iowa standards. Stature, as indicated by standing and s i t t i n g height, was more severely affected than weight. Upper arm measurements were found to indicate l e s s adipose tissue than expected as compared with standards, while s k e l e t a l muscle i s well maintained i n comparison with standard percentile curves. I t i s concluded that protein n u t r i t i o n a l status of B.C. Indian children l i v i n g i n student residences may be r e l a t i v e l y better than c a l o r i e n u t r i t i o n a l 80 status. The growth pattern of head circumference r e f l e c t s that of stature, p a r t i c u l a r l y i n females. I t i s possible that these patterns are due to n u t r i -t i o n a l factors, although i n t e r p r e t a t i o n of the r e s u l t s on that basis i s not wholly j u s t i f i a b l e i n view of the lack of dietary information. Recommendations Following int e r p r e t a t i o n of the r e s u l t s , several re-commendations can be made: 1. A study to obtain growth data on preschool Native Indian children should be undertaken i n order to determine the growth status of t h i s age group. Since the r e s u l t s of the present study indicate a growth d e f i c i t i n B.C. Native In-dian children, p a r t i c u l a r l y i n children of the younger age groups studied, the need for information on preschool c h i l d -ren i s c l e a r . 2. Growth data on Native Indian children l i v i n g on reserves should be obtained i n conjunction with dietary data i n order to determine growth patterns of those children l i v i n g i n the home environment, as related to n u t r i t i o n a l f a c t o r s . In comparison with r e s u l t s of the present study, the e f f e c t s of residence diets upon growth patterns could be delineated. 3. Health personnel at the student residences should keep s e r i a l height and weight charts on those children who are undersized, i n order to assess t h e i r growth patterns i n the school environment. 81 BIBLIOGRAPHY Abraham, S., Lowenstein, F.W. and O'Connell, D.E. Pre-liminary findings of the F i r s t Health and N u t r i -t i o n Examination Survey, 1971-1972. U.S. Depart-ment of Health, Education and Welfare. Public Health Service. Health Resources Administration. National Center for Health S t a t i s t i c s . DHEW Pub. No. (HRA) 75-1229, Rockville, Maryland, 1975. Addy, N. 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Ped. 21(2) :90-92, 1975. 92 APPENDICES Legends to Appendices Page Legend to Student Residence 93 Legend to ReserverCodes 9 4 93 LEGEND TO STUDENT RESIDENCE 00 Sechelt Student Residence, Sechelt, B.C. 01 St. Mary's Student Residence, Mission, 'B.C. 02 Kamloops Student Residence, Kamloops, B.C. 03 Cariboo Student Residence, Williams Lake, B.C. 04 Lejac Student Residence, Lejac, B.C. 10 St. George's Student Residence, Lytton, B.C. 94 LEGEND TO RESERVE CODES Reserve Code Reserve Code Adams Lake 1 Hope 24 Alexandria 2 Kanaka Bar 25 Alexis Creek 3 Kitwancool 26 A l k a l i Lake 4 Klahoose 27 Anaham 5 Kluskus 28 Anderson Lake 6 Kwawkewlth 29 Boothroyd 7 Lake Babine 30 Bridge River 8 L i l l o o e t 31 Burrard 9 Lower Nicola 32 Canim Lake 10 L t . Shuswap 33 Canoe Creek 11 Lytton 34 Chehalis 12 Matsqui 35 Chemainus 13 McLeod Lk. 36 Cheslatta 14 Moricetown 37 Clinton 15 Mount Currie 38 Coldwater 16 Musqueum 39 Cook's Ferry 17 Nanaimo 40 Cowichan 18 Nazko 41 Deadman1s Creek 19 Necoslie 42 Douglas 20 Nemiah Valley 43 Fountain 21 Neskainleth 44 Hazelton 22 Nicomen 45 Homalco 23 Nimpkish 46 95 Reserve Code Reserve Code Nooaitch 47 Soda Creek 63 North Thompson 48 Spallumcheen 64 Ohamil 49 Squami sh 65 Pavili o n 50 Squiala 66 Penelukut 51 Stellaquo 67 Penticton 52 Stone 68 Port Douglas 53 Stuart Lake 69 Samahquam 54 Takla Lake 70 Seabird 55 Toosey 71 Sechelt 56 Tsaw 72 Seton Lake 57 Ulkatcho 73 Shakan 58 Upper Nicola 74 Shuswap 59 Westbank 75 Skookumchuk 60 Williams Lake 76 Skwah 61 Yale 77 Sliammon 62 Non status 88 APPENDIX A STANDING HEIGHT, SITTING HEIGHT, SITTING HEIGHT/STANDING HEIGHT RATIO AND WEIGHT (sorted according to sex and age) CODE RES- RESI- SEX AGE .: STANDING SITTING SIT/ST WEIGH JMBER ERVE DENCE 6.40 160 45 144 1590 49.1 76 38 01 M 6.41 \u00E2\u0080\u00A2 195 54 169 2250 52.3 84 55 01 M 6.44 186 48 153 1809 52.0 385 76 02 M 6.45 162 46 145 1661 49.1 406 76 02 M 6.61 17 7 50 160 1963 51.7 73 38 01 M 6.6 3 164 45 142 1590 52.3 659 7 10 M 6.65 176 48 152 1809 49.8 666 25 10 M 6.65 188 53 167 2206 52.4 4G5 3 02 \u00C2\u00A5, 6.66 165 43 135 1452 48.7 81 65 01 M 6. 70 195 53 166 2206 50.4 541 42 03 M 6.72 193 53 169 2206 52.3 3 84 3 02 M 6.75 168 44 138 1520 48.8 74 60 01 M 6.77 183 49 156 1885 53.8 404 63 02 M 6.81 178 49 154 1885 51.6 395 2 02 M 6.62 165 46 146 1661 49.5 387 3 02 \u00C2\u00AB 6.67 152 43 135 1452 51.1 658 88 10 K 6.89 166 44 140 1520 51.2 75 24 01 M 6.57 190 52 165 2123 53.1 413 3 02 M 7.03 150 42 134 13 85 51.1 415 76 02 N 7.11 170 50 159 1963 49.0 417 5 02 M 7.15 168 48 152 1809 49.3 83 55 01 M 7.17 165 48 .151 1805 45.5 535 32 03 M 7.15 171 47 149 1734 52.8 412 5 02 M 7.20 150 42 134 1385 47.6 386 5 02 M 7.20 156 43 137 1452 47.7 63 62 00 M 7.35 188 52 164 2123 51.0 394 10 02 M 7.44 165 48 152 1805 49.2 416 10 02 N 7.44 162 47 149 1734 48.9 418 5 02 M 7.45 150 44 138 1520 47.0 414 71 02 M 7.47 171 48 150 18C9 50.6 536 1 03 H 7.52 178 50 157 1963 51.6 392 71 02 M 7. 56 176 49 155 1885 51.6 415 11 02 M 7.65 170 49 154 1885 50.2 393 11 02 M 7.74 173 49 155 1885 51.2 87 12 01 M 7.87 183 52 164 2123 52.6 661 26 10 K 7.89 176 49 155 1885 51.7 660 26 10 M 7. 85 183 51 161 2042 51.9 376 5 02 M 7.50 189 54 170 2250 51.0 70 38 00 M 7.54 185 50 158 1963 52.5 389 43 02 M 7.56 180 50 157 1563 50.8 65 46 00 M 7.56 175 50 158 1963 52.0 537 21 C3 M 8.01 192 51 160 2042 53.2 402 28 02 M 8.C7 191 52 166 2123 53.2 400 3 02 H 8.08 183 51 161 2042 51.5 538 16 03 M 8.12 177 51 160 2042 50.3 C O D E R E S - R E S I - S E X A C E IMBER E R V E D E N C E ( V R S ; 3 9 9 3 0 2 M 8 . 1 3 5 4 4 7 4 0 3 M 8 . 1 3 6 5 7 2 5 1 0 M 8 . 1 4 6 7 6 0 0 M 8 . 1 5 7 2 3 8 0 1 K 8 . 1 6 8 5 6 5 0 1 N 6 . 1 7 7 7 6 0 0 1 M 8 . 1 8 3 7 7 2 8 0 2 K 8 . 2 5 6 0 3 8 0 0 M 8 . 3 0 6 6 7 3 4 1 0 fs 8 . 3 1 6 6 5 3 4 1 0 M 8 . 3 6 6 6 2 5 8 1 0 M 8 . 3 5 3 9 7 4 3 0 2 M 8 . 4 0 7 9 5 5 0 1 M 6 . 4 0 5 4 3 7 3 0 3 M 8 . 4 1 3 7 4 7 1 0 2 M 8 . 4 4 8 6 5 5 0 1 M 6 . 4 8 3 7 9 6 8 0 2 M 8 . 5 0 5 4 0 7 4 0 3 M 8 . 5 8 5 4 2 5 9 0 3 M 8 . 6 7 8 2 6 0 0 1 M 8 . 7 0 4 0 3 5 0 2 M 8 . S O 5 4 5 3 3 0 3 M 8 . 8 7 6 6 4 3 4 1 0 M 8 . 9 7 5 4 6 2 0 0 M 8 . 5 5 1 0 2 2 4 0 1 M 9 . 0 3 5 5 1 5 7 0 3 M 5 . 0 4 3 7 3 4 3 0 2 M 5 . C 5 5 5 3 1 0 3 M 9 . 0 9 6 6 5 7 1 0 M 5 . 1 0 5 7 6 5 0 0 M 5 . 1 2 4 0 5 1 0 0 2 M 9 . 1 3 8 0 6 0 0 1 M 5 . 1 4 6 1 3 8 0 0 M 9 . 1 4 5 5 0 5 7 0 3 M 5 . 1 8 6 7 3 4 5 1 0 M 5 . 3 1 3 9 6 5 0 2 M 9 . 3 3 3 8 8 5 0 2 M 5 . 3 7 3 8 0 2 0 2 M 9 . 4 3 6 2 3 8 0 0 M 9 . 4 5 5 5 2 1 6 0 3 M 5 . 4 6 5 6 5 6 0 0 M 9 . 4 8 6 6 8 3 4 10 5 . 5 5 6 5 6 2 0 0 M 9 . 5 5 9 2 1 8 0 1 M 9 . 5 9 6 7 2 3 7 1 0 H 5 . 5 5 4 3 6 4 3 0 2 M 5 . 5 5 3 7 5 5 0 2 P 9 . 6 4 6 6 3 3 4 1 0 M 5 . 6 5 6 7 1 2 6 1 0 M 5 . 6 5 3 8 2 3 0 2 M 9 . 6 6 5 3 5 8 0 3 M 5 . 7 0 4 0 1 2 8 0 2 M 9 . 7 2 9 1 3 8 0 1 f 5 . 8 2 4 2 0 5 0 2 M 5 . 8 6 A R M U P P E R A R M M U S C L E H E A D 128 ; I R C D I AM C I R C A R E A C I R C M M ) ( M M ) ( M M ) ( M M * * 2 ) ( C M ) 1 7 3 4 9 1 5 4 1 8 8 5 5 0 . 2 1 8 7 5 1 1 6 3 2 0 4 2 5 3 . 0 1 8 4 5 2 1 6 4 2 1 2 3 5 1 . 5 1 8 0 4 9 1 5 7 1 8 8 5 5 5 . 5 1 7 6 5 0 1 5 8 1 9 6 3 5 6 . 5 1 8 8 5 2 1 6 6 2 1 2 3 5 2 . 2 2 0 3 5 6 1 7 7 2 4 6 3 5 4 . 4 1 8 0 5 1 1 6 2 2 0 4 2 5 0 . 8 1 5 6 5 6 1 7 7 2 4 6 3 5 2 . 3 1 7 4 4 7 1 4 8 1 7 3 4 5 1 . 2 1 7 0 4 6 1 4 5 1 6 6 1 5 0 . 8 1 7 3 4 6 1 4 5 1 6 6 1 5 3 . 2 1 8 9 5 3 1 6 9 2 2 0 6 5 1 . 0 1 5 3 5 3 1 6 9 2 2 0 6 5 3 . 7 1 5 1 5 4 1 7 0 2 2 9 0 5 0 . 8 1 8 2 5 1 1 6 2 2 0 4 2 5 0 . 2 1 8 4 5 1 1 6 2 2 0 4 2 5 2 . 1 1 8 5 5 2 1 6 5 2 1 2 3 5 1 . 5 2 1 1 5 5 1 7 4 2 3 7 5 5 2 . 9 1 5 3 5 5 1 7 5 2 3 7 5 5 4 . 2 2 0 0 5 2 1 6 5 2 1 2 3 5 3 . 1 1 6 6 4 8 1 5 2 1 8 0 9 5 1 . 4 1 9 7 5 4 1 7 0 2 2 5 0 5 4 . 8 1 5 9 4 6 1 4 4 1 6 6 1 5 1 . 3 2 2 0 5 9 1 8 7 2 7 3 3 5 3 . 8 2 0 4 5 8 1 8 4 2 6 4 2 5 4 . 0 2 0 8 5 7 1 8 1 2 5 5 1 5 5 . 5 1 7 5 4 9 1 5 5 1 8 8 5 5 1 . 4 1 9 1 5 3 1 6 8 2 2 0 6 5 2 . 7 1 9 6 5 6 1 7 6 2 4 6 3 5 1 . 8 1 9 8 5 4 1 7 1 2 2 9 0 5 2 . 0 1 9 9 5 6 1 7 7 2 4 6 3 5 2 . 8 1 5 0 5 2 1 6 4 2 1 2 3 5 3 . 4 1 7 0 4 9 1 5 3 1 8 8 5 5 0 . 6 2 0 2 5 8 1 8 5 2 6 4 2 5 3 . 5 1 5 3 5 5 1 7 3 2 3 7 5 5 2 . 6 1 7 7 5 2 1 6 6 2 1 2 3 5 3 . 3 1 9 0 5 4 1 7 2 2 2 9 0 5 0 . 7 1 8 4 5 1 1 6 2 2 0 4 2 5 2 . 2 1 9 0 4 9 1 5 7 1 8 8 5 5 1 . 5 1 6 5 4 7 1 4 9 1 7 3 4 5 0 . 6 2 1 2 5 9 1 8 6 2 7 3 3 5 4 . 2 1 9 4 5 2 1 6 4 2 1 2 3 5 2 . 5 1 9 3 5 5 1 7 3 2 3 7 5 5 4 . 5 1 5 4 5 5 1 7 3 2 3 7 5 5 2 . 8 2 1 0 5 9 1 8 7 2 7 3 3 5 5 . 9 2 1 0 6 1 1 9 3 2 9 2 2 5 3 . 6 1 8 3 5 2 1 6 5 2 1 2 3 5 2 . 8 2 0 2 5 6 1 7 6 2 4 6 3 5 3 . 0 1 9 0 5 1 1 6 1 2 0 4 2 5 1 . 0 1 7 7 5 0 1 5 8 1 9 6 3 5 0 . 6 1 5 3 5 4 1 7 2 2 2 5 0 5 1 . 8 2 0 6 5 6 1 7 8 2 4 6 3 5 3 . 2 1 5 0 5 4 1 6 9 2 2 9 0 5 5 . 5 2 0 0 5 6 1 7 6 2 4 6 3 5 4 . 0 C O D E R E S - R E S I - S E X A G E JMBER E R V E D E N C E ( Y R S 1 4 2 9 6 3 0 2 M 9 . 8 7 6 4 3 8 GO Ns 9 , 8 9 5 4 9 5 7 0 3 M 9 . 9 6 3 9 2 3 0 0 M 1 0 . 0 0 5 3 4 2 1 0 3 M 1 0 . 0 0 4 2 2 4 1 0 2 M 1 0 . 0 1 3 9 1 4 1 0 2 M 1 0 . 0 2 7 0 8 3 4 1 0 W 1 C . C 5 6 7 0 3 4 1 0 M 1 0 . 0 5 3 9 8 6 8 0 2 K 1 0 . 1 0 1 1 0 1 8 0 1 M 1 0 . 1 1 5 5 7 2 CO M 1 0 . 1 3 9 5 6 0 0 1 M 1 0 . 2 0 5 8 3 8 CO M 1 0 . 2 2 5 9 6 5 0 0 M 1 0 . 2 3 6 3 1 6 9 0 4 ft 1 0 . 2 4 4 3 1 \u00E2\u0080\u00A2a 0 2 M 1 0 . 2 8 1 0 8 6 0 0 1 M 1 0 . 3 7 4 3 5 4 1 0 2 M 1 0 . 4 1 5 4 8 5 7 0 3 M 1 0 . 4 3 4 9 9 CO M 1 0 . 4 5 4 0 6 2 CO M 1 0 . 4 5 1 0 4 1 2 0 1 M 1 0 . 4 6 4 4 5 3 0 2 H 1 0 . 4 6 7 1 4 3 4 1 0 M 1 0 . 5 1 1 0 7 6 0 0 1 M 1 0 . 5 6 4 5 0 4 1 0 2 K 1 0 . 6 4 7 0 9 3 4 1 0 M 1 0 . 6 5 7 0 4 3 4 1 0 K 1 0 . 6 9 4 2 5 1 1 C 2 M 1 0 . 7 0 3 6 5 6 0 0 M 1 0 . 7 7 4 3 4 4 3 0 2 M 1 0 . 7 8 4 3 0 5 0 2 M 1 0 . 8 3 4 2 4 4 3 0 2 M 1 0 . 8 4 1 2 1 6 0 0 1 K 1 0 . 8 8 1 0 6 6 0 0 1 M 1 0 . 9 2 7 1 0 3 4 1 0 H 1 0 . 9 3 9 4 3 1 C I M 1 0 . 9 8 5 1 4 6 CO M 1 0 . 9 9 4 4 6 2 8 0 2 M 1 0 . 9 9 1 0 5 3 5 0 1 M 1 0 . 9 9 9 6 2 4 0 1 M 1 1 . 0 3 9 3 3 5 0 1 K 1 1 . 0 3 4 3 7 2 8 0 2 M 1 1 . 0 4 4 5 4 5 0 2 M 1 1 . 0 6 7 0 2 2 6 1 0 M 1 1 . 1 2 9 7 6 0 0 1 M 1 1 . 1 4 4 4 4 3 0 2 K 1 1 . 1 4 5 5 5 2 1 0 3 M 1 1 . 1 6 9 8 5 5 0 1 M 1 1 . 2 3 6 6 2 9 0 0 K 1 1 . 2 6 1 1 9 3 8 0 1 M 1 1 . 2 7 4 2 1 5 0 2 M 1 1 . 2 8 5 5 4 8 C 3 K 1 1 . 3 2 5 0 3 8 CO M 1 1 . 3 3 A R M U P P E R A R M M U S C L E H E A D 129 ; I R C D I AM C I R C A R E A C I R C M M ) {MM ) ( M M ) ( M M * * 2 ) ( C M ) 1 8 5 5 1 1 6 0 2 0 4 2 5 4 . 6 1 8 5 5 0 1 5 7 1 9 6 3 5 3 . 2 1 9 6 5 6 1 7 6 2 4 6 3 5 2 . 0 2 1 0 5 7 1 8 1 2 5 5 1 5 4 . 5 1 6 5 4 6 1 4 5 1 6 6 1 5 1 . 2 2 0 3 5 9 1 8 6 2 7 3 3 5 3 . 7 1 7 8 5 1 1 6 1 2 0 4 2 5 2 . 3 1 9 3 5 2 1 6 4 2 1 2 3 5 3 . 0 1 9 4 5 4 1 7 0 2 2 9 0 5 3 . 7 1 9 6 5 1 1 6 0 2 0 4 2 5 3 . 5 1 8 1 5 1 1 6 1 2 0 4 2 5 1 . 6 2 4 8 6 3 1 9 9 3 1 1 7 5 4 . 0 1 8 0 5 1 1 6 0 2 0 4 2 5 4 . 4 1 9 3 5 2 1 6 4 2 1 2 3 5 1 . 3 2 1 2 5 7 1 8 0 2 5 5 1 5 2 . 7 2 0 6 5 8 1 8 5 2 6 4 2 5 4 . 2 1 8 2 5 2 1 6 4 2 1 2 3 5 2 . 2 1 9 0 5 0 1 5 9 1 9 6 3 5 2 . 2 1 8 7 5 3 1 6 9 2 2 0 6 5 4 . 2 2 3 3 6 2 1 9 7 3 0 1 9 5 5 . 6 2 2 1 6 2 1 9 6 3 0 1 9 5 3 . 5 1 8 2 5 1 1 6 1 2 0 4 2 5 2 . 8 2 2 3 6 0 1 9 1 2 8 2 7 5 4 . 6 1 8 7 5 3 1 6 8 2 2 0 6 5 3 . 4 1 9 6 5 4 1 7 0 2 2 9 0 5 4 . 1 2 0 0 5 5 1 7 3 2 3 7 5 5 3 . 2 1 9 7 5 6 1 7 7 2 4 6 3 5 2 . 5 1 9 0 5 2 1 6 5 2 1 2 3 5 2 . 6 2 0 0 5 5 1 7 3 2 3 7 5 5 2 . 9 2 0 0 5 8 1 8 5 2 6 4 2 5 4 . 4 2 1 4 5 8 1 8 2 2 6 4 2 5 3 . 3 2 1 1 6 2 1 9 5 3 0 1 9 5 4 . 7 2 1 1 5 8 1 8 4 2 6 4 2 5 2 . 6 1 9 2 5 3 1 6 9 2 2 0 6 5 2 . 8 2 1 8 5 9 1 8 8 2 7 3 3 5 6 . 0 2 0 8 5 9 1 8 5 2 7 3 3 5 1 . 2 1 9 6 5 3 1 6 9 2 2 0 6 5 4 . 2 1 7 2 4 8 1 5 2 1 8 0 9 5 0 . 2 2 1 0 5 8 1 8 2 2 6 4 2 5 5 . 2 1 9 6 5 3 1 6 9 2 2 0 6 5 4 . 3 1 9 9 5 3 1 6 8 2 2 0 6 5 4 . 3 1 9 9 5 7 1 7 9 2 5 5 1 5 2 . 3 1 8 3 5 1 1 6 2 2 0 4 2 5 3 . 0 1 8 5 5 4 1 7 1 2 2 9 0 5 3 . 8 2 0 3 5 7 1 8 1 2 5 5 1 5 3 . 7 1 9 5 5 5 1 7 5 2 3 7 5 5 3 . 5 2 C 9 5 7 1 7 9 2 5 5 1 5 7 . 6 2 0 1 5 5 1 7 4 2 3 7 5 5 4 . 6 1 8 5 5 3 1 6 8 2 2 0 6 5 0 . 4 2 0 9 5 6 1 7 6 2 4 6 3 5 3 . 0 1 9 7 5 2 1 6 4 2 1 2 3 5 5 . 2 1 9 2 5 4 1 6 9 2 2 9 0 5 5 . 8 1 9 7 5 5 1 7 4 2 3 7 5 5 1 . 1 1 8 6 5 1 1 6 1 2 0 4 2 5 4 . 4 2 1 0 5 8 1 8 3 2 6 4 2 5 5 . 0 CODE RES- RESI- SEX AGE ARM UPPER ARM MUSCLE HEAD IMBER ERVE DENCE (YRS) CIRC 01 AM CIRC AREA CIRC 1 MM) (MM) (MM) (MM#*2) (CM) 573 50 03 M l l . 3.3 2G6 58 184 2642 53.0 452 3 02 M 11.37 180 52 164 2123 53.0 632 69 04 M. 11.35 210 58 183 2642 53.8 120 65 01 M 11.40 210 5 7 182 2551 55.0 42 23 GO M 11.41 183 51 162 2042 51.0 53 38 00 M 11.41 223 60 190 2827 56.0 556 15 03 M 11.46 193 55 175 2375 54.9 113 31 01 K 11.48 212 58 185 2642 54.9 423 10 02 M 11.49 186 54 169 2290 54.4 101 60 01 M 11.5.7 186 53 168 2206 52. G 432 5 02 M 11.58 178 51 162 2042 51.0 448 11 02 M 11.5.8 193 54 172 2250 54.6 445 5 02 M 11.58 204 56 176 2463 54.2 428 73 02 M 11.61 194 55 174 2375 54.7 31 38 00 M 11.63 22 0 60 190 28 27 54.8 546 57 03 H 11.63 234 65 205 3318 56.7 90 55 01 M 11.72 207 58 184 2642 53. 8 52 9 00 M 11.75 228 63 199 3117 55.2 89 65 01 M 11.77 224 64 203 3216 52.7 706 34 10 M 11.85 215 54 172 2250 53.2 433 10 02 M 11.54 182 51 162 2042 52.2 112 60 01 M 11.54 208 56 175 2463 55.0 558 33 03 M 11.54 210 59 185 2733 55.0 62 6 69 04 M 11.55 214 61 192 2922 53.3 627 36 04 M 12.01 203 54 170 2250 56.5 123 60 01 M 12. 04 195 55 174 23 75 52.6 707 22 10 K 12.13 222 63 200 3117 54.4 443 68 02 M 12.14 189 52 164 2123 53. 0 115 61 01 M 12.15 185 52 166 2123 54.1 117 55 01 M 12. 2 0 228 65 204 3318 54.5 711 45 10 M 12.21 206 60 189 2827 51.8 118 55 01 ft 12.23 218 58 183 2642 55.4 705 34 10 M 12.28 211 58 184 2642 55.1 116 66 01 M 12.25 203 55 175 2375 52.6 567 16 03 K 12.31 218 62 195 3019 53.5 440 5 02 M 12.33 203 60 188 2827 53.5 560 1 03 \u00C2\u00A5< 12.37 223 62 197 3019 53.7 427 5 02 M 12.41 220 62 196 3019 54.9 426 5 02 M 12.42 211 58 183 2642 52.2 693 34 10 f, 12.45 192 57 179 2551 51.0 699 88 10 M 12.46 227 61 153 2 522 54.1 465 11 02 M 12.47 217 62 195 3019 54.1 103 55 01 M 12.51 203 58 182 2642 54.8 471 68 02 M 12.52 232 64 203 3216 55.8 451 68 02 M 12.54 203 60 188 28 27 55.6 625 70 04 Vi 12.62 248 70 222 3848 54.8 43 27 00 M 12.64 210 61 153 2922 51.6 630 3 0 04 Vi 12.64 223 65 206 3318 57.2 700 34 10 M 12.66 218 60 191 2827 58.6 479 4 02 M 12.69 213 62 197 3015 99. 9 435 73 02 M 12.69 226 65 206 3318 55.0 565 57 03 M 12.7.1 216 61 192 2922 56.5 473 5 02 M 12.71 244 69 218 3739 55.7 698 58 10 K 12.73 2G5 59 186 2733 52.5 561 21 03 M 12.73 2 06 59 185 2733 55. 3 CODE RES- RESI- SEX AGE ARM UPPER ARM MUSCLE HEAD IMBER ERVE DENCE (YRS) CIRC DI AM CIRC AREA CIRC (MM) (MM) (MM) (MM**2) (CM) 438 71 02 M 12. 7.7 196 56 177 2463 5-1.8 568 75 03 M 12.78 276 70 221 3848 57.0 703 3 7 10 M 12.8 2 230 66 209 3421 55.0 447 41 02 M 12.82 218 60 191 2827 56.0 \u00E2\u0082\u00AC95 34 10 K 12.82 218 60 189 2827 57.8 88 65 01 M 12. \u00C2\u00A35 22 5 64 201 3216 52.7 634 69 04 M 12.92 256 72 227 4071 57.7 32 38 CO M 12.97 200 57 180 2551 51.8 547 48 03 M 12.98 2 04 57 179 2551 55.5 712 34 10 M 12.99 212 61 193 29 22 57.2 647 30 04 M 12.99 236 65 206 3318 58.2 694 34 10 M 13.00 195 56 177 2463 51.4 696 34 10 M 13.05 194 55 173 2375 55.0 713 34 10 M 13.07 182 51 161 2042 53.8 99 60 01 M 13.12 210 59 186 2733 54.2 633 30 04 13.14 220 63 200 3117 53.0 572 16 03 M 13.14 203 59 188 2733 55.8 3 5 56 CO M 13.15 212 61 193 2922 56.9 474 10 02 M 13.15 194 56 176 2463 53.8 453 71 02 M 13.15 218 58 185 2642 56.6 74 7 22 \u00E2\u0080\u009E 10 K 13.26 232 66 210 3421 54.6 442 11 02 M 12.30 197 57 179 2551 53.0 697 34 10 M 13.30 197 56 177 2463 55.0 141 55 CI 13.31 216 61 193 2922 54.3 640 69 04 M 13.21 242 70 221 3848 54.4 743 34 10 K 13.33 230 66 209 3421 56. 5 3 7 62 00 M 13.34 242 70 220 3848 57.2 559 74 03 M 13.36 225 63 200 3117 55.8 134 55 01 M 13.38 233 66 210 3421 55.2 566 16 03 M 13.41 206 58 185 2642 54.5 648 30 04 M 13.46 233 68 213 3631 57.1 124 60 01 M 13.50 219 62 195 3019 54.7 466 5 02 M 13.51 199 57 179 2551 54.0 122 31 01 M 12.51 190 51 161 2042 54.3 441 61 02 M 13.53 210 59 186 2733 51.7 114 38 01 M 1.3.5.3 230 62 197 3019 51.7 111 55 01 H 13.59 217 60 189 2827 54.0 562 21 03 M 13.65 225 63 197 3117 54.5 154 38 01 M 13.7.0 206 58 184 2642 57.2 462 3 02 M 13.71 227 63 200 3117 56.9 639 70 C4 M 12.76 212 63 198 3117 54.1 564 6 03 M 13.80 212 62 195 3019 54.8 459 5 02 N. 13.80 223 63 199 3117 55.3 463 5 02 M 13.81 233 66 207 3421 56.3 476 5 02 M 13.85 245 73 231 4185 56.1 100 38 01 M 13.88 223 64 201 3216 53.5 470 28 02 M 13.91 223 63 200 3117 57.6 646 42 04 M 13.9.8 215 61 193 2922 53.3 156 60 01 M 14.02 230 64 202 3216 55.6 483 71 02 M 14.06 208 59 186 2733 54,1 145 60 01 M 14.08 220 62 197 3019 56.5 30 23 CO M 14.0 8 210 61 194 2922 53.3 461 5 02 M 14.09 226 67 210 3525 54.2 748 34 10 M 14.11 270 74 234 4300 57.7 484 28 02 M 14.12 216 63 198 3117 57.4 C O D E R E S - R E S I - S E X A G E IMBER E R V E D E N C E ( Y R S 1 571 57 03 M 14.16 745 7 10 M 14.20 742 34 10 M 14.24 478 28 02 M 14.25 155 60 01 M 14.30 635 30 04 M 14.30 565 57 03 K 14.32 64S 30 04 K 14.34 588 57 03 M 14.24 45 e 3 02 M 14.36 563 21 03 M 14.35 744 34 10 M 14.41 641 70 04 M 14.48 741 22 10 M 14.51 638 70 04 M 14.58 557 16 03 M 14.55 701 34 10 M 14.59 472 5 02 M 14.62 133 77 01 M 14.64 151 54 01 M 14.66 457 5 02 K 14.65 750 34 10 M 14.71 642 37 04 M 14.72 469 54 02 M 14.78 593 8 03 M 14.86 135 38 01 N 14.87 456 5 02 M 14.8 8 146 12 01 M 14.8 8 140 18 01 M 14.56 33 23 00 M 14.5 8 570 50 03 M- 14.55 464 5 02 M 15.04 651 30 04 M 15.05 467 5 02 K 15.10 652 42 04 M 15.11 596 16 03 K 15.14 460 88 02 K 15. 18 598 21 03 M 15.20 148 51 01 M 15.25 637 70 04 M 15.26 597 38 03 M 15.22 734 34 10 M 15.33 735 34 10 M 15.38 590 57 03 M 15.39 13 \u00C2\u00A3 49 01 K 15.42 34 23 CO M 15.44 153 62 01 M 15.46 145 60 01 M 15.47 477 5 02 M 15.49 152 39 01 M 15.54 480 5 02 M 15.57 650 70 04 K 15.58 482 4 02 M 15.55 468 71 02 M 15.61 736 34 10 M 15.62 A R M U P P E R A R M M U S C L E H E A D 132 ; I R C O I A M C I R C A R E A C I R C MM) ( M M ) ( M M ) ( M M * * 2 ) ( C M ) 2 3 3 6 6 2 0 7 3 4 2 1 5 6 . 7 2 1 5 6 1 1 9 3 2 9 2 2 5 5 . 8 2 1 5 6 2 1 5 4 3 0 1 9 5 5 . 5 2 0 8 5 9 1 8 7 2 7 3 3 5 4 . 8 2 1 5 6 1 1 9 3 2 9 2 2 5 5 . 8 2 4 6 7 0 2 2 1 3 8 4 8 5 9 . 6 2 6 0 7 1 2 2 3 3 9 5 9 5 9 . 9 2 3 1 6 5 2 1 6 3 7 3 9 5 7 . 9 2 3 6 6 6 2 0 8 3 4 2 1 5 6 . 6 2 1 2 6 2 1 9 5 3 0 1 9 5 3 . 7 2 1 0 5 6 1 7 6 2 4 6 3 5 4 . 7 2 4 3 6 9 2 1 8 3 7 2 9 5 4 . 5 2 2 1 6 4 2 0 1 3 2 1 6 5 5 . 2 2 3 9 6 9 2 1 8 3 7 3 9 5 5 . 8 2 2 3 6 5 2 0 7 3 3 1 8 5 5 . 8 2 4 3 6 9 2 1 9 3 7 3 9 5 5 . 8 2 1 0 6 0 1 8 8 2 8 2 7 5 4 . 7 2 0 3 5 7 1 7 9 2 5 5 1 5 4 . 0 1 5 5 5 3 1 6 7 2 2 0 6 5 1 , 5 2 4 5 7 0 2 2 2 3 8 4 8 5 7 . 7 2 4 4 7 1 2 2 5 3 9 5 9 5 5 . 8 2 4 8 7 2 2 2 8 4 0 7 1 5 6 . 6 2 0 5 5 9 1 8 6 2 7 3 3 5 3 . 9 2 2 8 6 6 2 0 8 3 4 2 1 5 6 . 0 2 5 5 7 3 2 2 9 4 1 8 5 5 8 . 4 1 8 6 5 4 1 7 1 2 2 9 0 5 4 . 6 2 4 2 6 8 2 1 4 3 6 3 1 5 6 . 6 2 0 5 5 9 1 8 8 2 7 3 3 5 3 . 4 2 2 5 6 2 1 9 6 3 0 1 9 5 4 . 3 2 6 7 7 7 2 4 5 4 6 5 6 5 9 . 5 2 2 6 6 5 2 0 7 3 3 1 8 5 4 . 7 2 2 6 6 7 2 1 1 3 5 2 5 5 7 . 0 2 5 6 7 7 2 4 2 4 6 5 6 5 9 . 3 2 1 0 6 2 1 9 4 3 0 1 9 5 5 . 6 2 5 8 7 6 2 4 0 4 5 3 6 5 9 . 0 2 4 4 7 1 2 2 4 3 9 5 5 5 5 . 0 2 2 8 6 6 2 0 8 3 4 2 1 5 7 , 8 2 3 3 6 7 2 1 2 3 5 2 5 5 3 . 9 2 3 6 6 9 2 1 9 3 7 3 9 5 4 . 8 2 2 3 6 4 2 0 2 3 2 1 6 5 3 . 7 2 5 6 7 5 2 3 6 4 4 1 7 5 5 . 9 2 4 5 7 1 2 2 6 3 9 5 9 5 7 , 0 2 3 3 6 8 2 1 6 3 6 3 1 5 7 . 3 2 4 7 7 4 2 3 3 4 3 C G 5 8 . 5 2 1 1 6 1 1 9 2 2 9 2 2 5 3 , 9 2 7 5 8 2 2 5 9 5 2 8 1 5 7 , 5 2 2 5 6 5 2 0 5 3 3 1 8 5 4 . 4 2 5 2 7 1 2 2 3 3 9 5 5 5 5 . 9 2 5 3 7 4 2 3 3 4 3 0 0 5 6 . 3 2 8 3 8 4 2 6 4 5 5 4 1 5 7 . 9 2 2 1 6 1 1 9 3 2 9 2 2 5 5 . 6 2 3 3 6 8 2 1 4 3 6 3 1 5 4 . 7 2 4 4 7 2 2 2 6 4 0 7 1 5 7 . 4 2 1 3 6 2 1 9 5 3 0 1 9 5 5 . 9 2 6 8 7 9 2 5 0 4 9 0 1 5 9 . 5 CODE RES- R NUMBER ERVE D 587 38 733 34 455 41 585 33 740 22 481 41 135 66 644 36 591 57 751 45 645 69 745 22 753 57 475 63 595 16 737 16 594 57 75 2 16 643 36 73 5 34 586 21 754 57 147 39 585 21 131 9 129 38 15 7 60 755 21 655 69 636 70 127 23 653 36 126 23 592 38 654 36 323 21 142 55 137 18 160 3 8 270 3 269 43 262 2 281 68 48e 74 268 63 159 65 265 28 245 71 267 3 501 74 171 60 237 3 489 16 263 5 266 3 SI- SEX AGE ARM NCE (YRS) CIRC (MM) 03 M 15.70 234 10 M 15.70 248 02 M 15.73 222 03 15.76 2 57 10 M 1 5 . SI 265 02 M- 15.92 218 01 M 16.00 270 04 M 16.01 250 03 M 16.02 277 10 M 16.03 226 04 M 16.08 264 10 16.09 250 10 n 16. 18 250 02 M 16.30 205 03 M 16.32 23 8 20 M 16.35 251 03 M 16.37 240 10 M 16.4 2 240 04 M 16.43 258 10 K 16.44 260 03 M 16.45 236 10 M 16.50 280 01 M 16.55 228 03 M 16.56 258 01 K 16.57 230 01 M 16.62 225 01 M 16.71 255 10 K 16.72 240 04 M 16.75 273 04 \u00C2\u00A5. 1 6 . 7 5 250 01 M 16.76 260 04 M 16.78 260 01 H 16.85 253 03 M 16.87 244 04 M 16.88 261 02 K 16.92 263 01 M 16. 92 257 01 M 16.93 265 01 F 6.01 175 02 F 6.05 156 02 F 6.09 180 02 F 6.10 170 02 F 6 .12 157 03 F 6.20 174 02 F 6.21 180 01 F 6.26 175 02 F 6.27 160 02 F 6.28 161 02 F 6.3 2 160 03 F 6.33 174 01 F 6.42 158 02 F 6.42 163 03 F 6.54 162 02 F 6.54 180 02 F 6.55 171 UPPER ARM MUSCLE 01 AM CIRC AREA (MM) (MM) ( M M**2) 68 214 3631 72 227 4071 65 205 3318 76 239 4536 80 251 5026 62 195 3019 78 245 4778 74 234 4300 80 254 5026 63 200 3117 78 246 4778 74 233 4300 71 226 3959 58 184 2642 70 220 3848 74 234 4300 68 216 3631 70 222 3 848 75 236 4417 76 241 4536 70 219 3848 81 256 5153 65 207 3318 77 242 4656 65 206 3318 64 203 3216 73 23 2 4185 71 224 3959 81 255 5153 72 229 40 71 76 239 4536 76 238 4536 72 229 4071 71 226 3959 77 244 4656 78 247 4778 74 235 4300 78 245 4778 47 149 1734 44 140 1520 50 158 1963 45 141 1590 44 141 1520 47 148 1734 51 161 2042 49 154 1885 44 140 1520 43 138 1452 42 134 1385 48 152 1809 43 136 1452 45 142 1590 44 141 1520 50 160 1963 47 148 1734 HEAD 133 CIRC ( C M ) 58.2 57.8 55.7 58.3 58. 1 56.5 56.1 58.9 58.3 5 7 . 1 59.0 56.6 58.8 54. 8 58.8 57. 0 58,3 58.7 57.0 58.7 56.9 58.3 57.8 58.3 55.8 55.6 57.0 57.5 59.9 54.8 56.0 5-7* 0 56.1 59.7 59,0 59.0 58.3 59.5 50.2 49.4 50.8 50.1 49.4 49.0 ' 5 - 1 . 1 48.1 48.7 48.7 48.0 49.1 48.6 49.5 47.8 48.4 47.6 C O D E R E S - R E S I - S E X A G E JMBER E R V E D E N C E ( Y R S 286 41 02 F 6o59 243 11 02 F 6.60 272 63 02 F 6.64 264 28 02 F 6.64 280 43 02 F 6.64 38 23 00 F 6.66 283 71 02 F 6.66 676 25 10 F 6.67 23 8 3 02 F 6.66 246 5 02 F 6.73 261 10 02 F 6.74 29 65 01 F 6.89 163 55 01 F 6.94 500 1 03 F 6.5 7 164 55 01 F 7.03 257 5 02 F 7.17 258 5 02 F 7.17 682 34 1G F 7 . 26 284 5 02 F 7.27 48 7 13 03 F 7.25 158 65 01 F 7.34 256 68 02 F 7.38 166 24 01 F 7.3 6 244 68 02 F 7.47 67 8 34 10 F 7.50 506 57 03 F 7. 51 275 5 02 F 7.56 168 38 01 F 7.58 259 11 02 F 7.59 172 6 0 01 F 7.65 250 71 02 F 7.6 8 276 3 02 F 7.74 26 0 3 02 F 7.74 680 7 10 F 7.82 44 23 00 F 7.84 46 38 00 F 7. 84 677 34 10 F 7.69 249 76 02 F 7.90 47 38 CO F 7.55 253 2 02 F 7.56 502 8 03 F 7.98 170 12 01 F 8.01 279 11 02 F 8.11 274 5 02 F 8.16 162 60 01 F 8.17 278 28 02 F 8.18 239 5 02 F 8.23 251 61 02 F \u00C2\u00A3o 26 674 32 10 F 8.27 247 3 02 F 6.28 248 10 02 F 8.29 24 65 00 F 8.3 1 511 42 03 F 8.32 27 62 00 F 8.36 679 34 10 F 8.41 A R M U P P E R A R M M U S C L E H E A O 134 : I R C D I A M C I R C A R E A C I R C [ MM) ( M M ) ( M M ) (MM**2) ( C M ) 149 40 126 1256 47.3 154 43 136 1452 51.7 178 49 156 1885 50.1 151 43 136 1452 50.7 184 50 159 1963 51.8 168 46 147 1661 46.3 158 41 130 1320 47.3 169 45 141 1550 50. 5 170 44 138 1520 50.1 173 47 148 1734 4 7.6 160 44 139 1520 49.1 208 56 177 2463 51.6 190 51 161 2042 51.8 193 51 160 2042 50.8 175 49 156 1885 51.3 159 46 144 1661 48.9 160 46 146 1661 49.8 193 51 161 2042 50.6 184 47 149 1724 50. 5 188 53 167 2206 50.3 190 51 161 2042 50.5 162 48 151 1809 49.0 170 49 156 1885 48.6 183 49 156 1885 50.9 182 48 153 1809 51.5 203 55 173 2375 55.8 195 53 169 2206 51.8 198 53 167 2206 52.0 182 45 144 1550 51.0 173 48 153 1809 50.1 195 50 157 1963 51.6 186 50 159 1963 51.5 185 51 161 2042 50.4 183 50 157 1963 49.9 187 50 157 1563 50.0 190 53 169 2206 51.4 161 45 142 1590 47.8 178 48 152 1809 51.3 176 49 155 1885 50.3 165 45 142 1590 49.8 189 49 156 1865 51.2 150 54 170 2250 52.5 192 50 159 1963 51.5 160 45 143 1550 49.4 182 50 158 1963 51.6 194 52 165 2123 52.0 169 47 148 1734 50.6 186 48 152 1809 50.7 173 48 151 1809 50.3 160 42 134 1385 51.0 180 51 161 2042 50.4 188 52 166 2123 52.3 215 59 186 2733 52.0 199 55 174 2375 50.4 180 49 154 1885 47.6 CODE RES- R NUMBER ERVE D 675 45 164 55 241 28 236 11 505 15 254 41 271 88 285 5 176 51 683 25 165 60 505 32 681 34 282 68 28 56 499 57 161 55 604 14 20 38 41 72 25 23 296 41 273 3 188 12 311 43 304 5 495 42 242 5 167 38 277 3 291 10 252 10 179 39 48 23 292 10 191 38 315 11 516 50 290 3 23 53 313 71 289 11 684 34 6 07 14 497 32 300 3 512 75 494 21 298 3 496 59 498 50 685 34 26 56 308 5 5 03 52 SI- SEX AGE ARM NCE (YRS) CIRC (MM) 10 F 8.42 196 01 F 8.43 180 02 F 8.47 183 02 F \u00E2\u0082\u00AC.53 175 03 F 8.62 185 02 F 8 .66 170 02 F 8.67 207 02 F 8.67 194 10 F 8.68 169 10 F e . 7 o 165 01 F 8.71 173 03 F 8.74 175 10 F 8.75 188 02 F 8.80 173 00 F 8.53 194 03 F \u00E2\u0082\u00AC.57 190 01 F 8.99 179 04 F 5.02 208 00 F 9.03 222 GO F 9.07 238 CO F 5.0 8 195 02 F 9.12 192 02 F 5.17 194 01 F 9.19 187 02 F 9.19 185 02 F 9.25 194 03 F 9.26 208 02 F 9.30 166 01 F 9.31 195 02 F 9.31 168 02 F 9.41 205 02 F 5.43 170 01 F 9.45 212 GO F 5.47 240 02 F 9.4 8 183 01 F 9.56 240 02 F 9.56 170 03 F 9.60 200 02 F 9.60 187 CO F 9.76 198 02 F 9.77 210 02 F 9.82 190 10 F 9.83 197 04 F 9.83 192 03 F 9.89 195 02 F 9.92 180 03 F 9.55 215 03 F 5.56 202 02 F 9.97 187 03 F 10.02 197 03 F 10.03 180 10 F 10.06 195 CO F 10oC.\u00C2\u00A3 212 02 F 10.17 210 03 F 10.1.7 223 UPPER ARM MUSCLE DIAM CIRC AREA (MM) (MM) (MM#*2) 54 170 2290 50 158 1963 52 163 2123 49 155 1885 52 163 2123 48 151 1809 56 177 2463 52 166 2123 47 149 1734 44 140 1520 48 151 1809 46 146 1661 54 170 2290 51 160 2042 53 168 2206 50 159 1963 49 156 1885 56 176 2463 59 187 2733 63 200 3117 53 167 22 06 51 161 2042 55 173 2375 53 168 2206 51 162 2042 54 171 2290 55 175 2375 46 147 1661 54 169 2290 47 150 1734 58 182 2642 48 153 1809 55 173 2375 68 214 3631 50 159 1963 61 193 2922 47 149 1734 52 i64 2123 50 159 1963 53 166 2206 55 175 237 5 55 175 2375 53 168 2206 54 170 2290 53 167 2206 48 151 1809 59 187 2733 5 3 168 2206 52 165 2123 55 173 23 75 48 152 1809 50 160 1963 59 185 2733 57 181 2551 58 185 2642 HEAD 135 CIRC (CM) 50.0 49.0 52.6 50.9 52.2 50.5 52.6 49.3 49.3 50.8 51.4 52.0 52.2 51.3 52.8 53.8 51.2 51.5 53. 5 53.4 50.9 50.9 51.4 53.8 52.8 50.4 53.2 50.1 54.0 48.3 51.1 47.8 52.5 50.4 52.8 54.5 52.3 53.1 50.5 51.0 53.6 52.0 52.8 51.7 52.5 51.7 52.0 53.2 51.5 52.3 50.8 52.0 54.9 52.8 52.9 CODE RES- RESI- SEX AGE IMBER ERVE DENCE (YPS) 606 69 C4 F 10.21 295 41 02 F 10.26 690 7 10 F 10.27 22 23 00 F 10.25 486 1 03 F 10.30 1 6 5 00 F 10 . 3 7 505 16 03 F 10.43 183 38 01 F 10.44 288 5 02 F 10.44 513 73 03 F 10.52 186 12 01 F 10.52 178 62 01 F 10.55 692 22 10 F 10.56 605 67 04 F 10.56 293 28 02 F 10.58 4 56 00 F 10.59 287 5 G2 F 1C.62 490 8 03 F 10.69 48 5 74 03 F 1 0 . 7 . 0 314 71 02 F 10.80 599 70 04 F 10.80 491 33 03 F 10.84 299 11 02 F 10.89 691 34 10 F 10.54 294 10 02 F 1 1 . 0 . 0 307 10 02 F 11. 08 343 3 02 F 11.12 306 41 G2 F 1 1 . 1 3 510 75 03 F 1 1 . . 1 . 6 301 71 02 F 11.19 18 62 00 F 1 1 . 2 . 0 514 64 03 F 11.27 508 59 03 F 11.28 312 68 02 F 11.25 687 7 10 F 11.32 602 14 04 F 11.32 7 62 00 F 11.33 492 13 03 F 11 . 3 3 689 45 10 F 11.35 333 5 02 F 1 1 . 4 1 608 30 04 F 11.42 305 5 02 F 11.51 12 65 00 F 11.54 5 62 CC F 11.54 303 28 02 F 11.55 533 57 03 F 11 . 6 1 310 58 02 F 11.62 309 68 02 F 11.72 686 34 10 F 11 . 7 3 16 38 00 F 11. 73 531 16 03 F 11.75 194 60 01 F 11.77 187 12 Gl F 11.81 181 56 01 F 11.83 688 34 10 F 11.8.7 A R M U P P E R A R M M U S C L E H E A D 136 ; I R C Dl AM C I R C A R E A C I R C MM) ( M M ) i MM) (MM**2) ( C M ) 183 51 162 2042 49.9 192 52 163 2123 51\u00C2\u00AB4 193 53 168 2206 54,0 183 52 163 2123 50.6 197 53 168 2206 51.8 212 57 179 2551 54.5 193 55 175 2375 51.1 196 55 174 2375 51.7 177 50 159 1963 50.3 215 60 191 2827 52.0 192 54 170 2290 50.2 206 57 180 2551 50.8 231 63 199 3117 55.3 221 61 194 2922 55.3 179 49 156 1885 5 0.7 205 5 7 180 2551 52.8 183 51 162 2042 51.8 191 53 169 2206 51.1 201 54 170 2250 52.3 184 50 157 1963 50.3. 214 61 192 25 22 53.8 213 57 181 2551 53.8 208 56 178 2463 51.8 274 71 2 24 35 59 56.6 157 56 178 2463 52.4 174 50 158 1563 45. 2 196 53 168 2206 52.7 197 54 170 2250 52.6 213 57 179 2551 50.8 183 51 161 2042 51.0 205 58 183 2642 53.5 215 58 182 2642 54.0 206 58 184 2642 52.8 154 55 173 2375 51.7 211 5 7 181 25 51 .51.7 189 54 170 2250 52.2 237 65 207 3318 52.6 196 55 174 2375 52.7 210 56 178 2463 53.2 193 56 176 2463 53.7 214 61 192 2922 55.8 200 55 174 23 75 52.2 235 62 195 3019 54.0 215 61 194 2922 52.8 213 59 185 2733 54.0 200 56 176 2463 52.6 211 60 190 2827 52.1 199 57 179 2551 53.0 197 57 180 2551 53.0 265 68 215 3631 56.8 200 56 176 2463 54.3 224 57 181 25 51 54.8 179 50 158 1963 51.4 210 59 187 2733 54.7 198 5 5 173 23 75 54.2 CODE RES- R NUMBER ERVE 0 526 57 532 8 517 38 603 70 515 21 297 c 318 10 190 38 601 42 319 15 302 41 600 30 189 38 3 62 518 74 729 34 717 34 15 38 722 7 177 60 623 14 33 0 3 184 24 326 5 17 62 493 57 619 69 2 38 523 57 19 65 339 3 618 30 520 38 335 28 528 73 195 20 320 10 331 3 334 5 611 37 325 5 153 60 727 34 11 62 316 3 525 50 180 77 9 38 507 8 6 88 328 28 217 23 720 22 715 34 317 43 SI- SEX AGE ARM NCE (YRS) CIRC (MM) 03 F 11.87 247 03 F 11.89 211 C3 F 11.94 218 04 F 11.58 210 03 F 1 2 . 0 1 192 0 2 F 12.02 186 02 F 12.04 216 01 F 12.07 225 04 F 12.09 217 02 F 12.12 214 02 F 12.16 249 04 F 1-2 .1 .8 186 0 1 F 12.20 208 00 F 12.23 219 03 F 12.31 223 10 F 12.35 236 10 F 12.50 225 CC F 12.54 220 10 F 12.55 206 CI F 12.57 228 04 F 12.61 227 02 F 12.62 217 01 F 12.67 248 02 F 12.70 240 00 F 12.77 268 03 F 12.78 238 04 F 12.79 234 CC F 12.83 222 03 F 12.84 252 00 F 1 2 . 8 . 5 225 02 F 12.87 150 04 F 12.87 235 03 F 12.88 223 02 F 12.90 2C4 03 F 12.52 227 01 F 12.56 203 02 F 12.58 236 02 F 12.58 218 C2 F 12.58 188 04 F 13.01 230 C2 F 13.02 190 01 F 1 3 . 0 4 216 10 F 1 3 . 0 . 7 208 CC F 13,12 230 02 F 13.13 178 03 F 13.19 202 01 F 13.19 222 CC F 12.2 2 227 03 F 13.2 2 257 GO F 13.23 203 02 F 13,24 238 01 F 13.28 233 10 F 12.25 244 10 F 13.32 212 C2 F 13.34 192 UPPER ARM MUSCLE DIAM CIRC AREA (MM) (MM) ( M M**2) 70 221 3848 57 181 2551 60 190 2827 60 191 2 827 55 173 2375 55 174 2375 62 197 3019 61 192 2922 57 180 2551 56 177 2463 73 230 4185 53 168 2206 58 183 2642 60 188 2827 60 191 2827 65 204 3318 62 197 3019 62 196 3019 56 177 2463 62 195 3019 62 196 3019 60 190 2827 68 214 3631 68 214 3631 71 224 3959 6 5 204 3318 62 196 3019 61 193 2922 69 217 3739 63 200 3117 52 165 2123 64 202 3216 62 195 3019 59 186 2733 61 194 2922 54 172 2290 68 214 3631 60 188 2827 51 161 2042 64 202 3216 53 169 2206 60 190 2827 56 178 2463 64 202 3216 50 159 1963 57 180 2551 62 195 3019 62 197 3019 64 203 3216 58 183 2642 65 207 3318 61 191 2922 66 209 3421 58 184 2642 55 175 2375 HEAD 1 3 7 CIRC (CN) 55.0 54.8 55.5 54 . 1 54.2 50.4 52.8 56.3 52,6 53. 8 53.2 52,8 53.6 54.0 53.3 56.6 55.0 52.9 54.6 54.3 53.9 53,7 55,5 54.9 54,2 55.3 53.3 53.1 55.5 53.5 54.7 5 7 . 0 56.8 54.8 55,3 5 - 1 . 0 . 5 4 . 8 56.0 53.6 53.9 50.9 55.5 53.8 54,1 50.4 52.6 54.7 5 3 . 2 56.9 50.6 56.4 53.5 55.0 54.2 55.4 CODE RES- RESI- SEX ACE ARM UPPER ARM MUSCLE HEAD IMBER ERVE DENCE (YRS) CIRC CI AM CIRC AREA CIRC I MM) (MM) (MM) (MH**2) (CM) 527 33 03 F 13,35 226 63 198 3117 54.2 617 70 04 F 13,40 246 63 198 3117 54.6 224 11 02 F 13 .41 200 56 176 2463 55,0 621 67 04 F 12.46 233 64 202 3216 56.0 524 50 03 F 13.46 2 53 65 207 3318 56.7 222 63 02 F 13.46 192 55 174 2375 53.6 730 34 10 F 12.48 206 55 174 2375 54.1 530 13 03 F 13.51 271 74 233 4300 56.3 346 73 02 F 13.51 236 67 210 3525 55.2 182 35 01 F 12.54 233' 60 191 2827 52.5 14 6 00 F 13.58 240 63 199 3117 52.8 341 68 02 F 12.59 208 58 182 2642 54.8 716 34 10 F 12.62 262 68 216 3631 57.0 243 68 02 F 13.62 213 57 181 2551 52.4 583 74 03 F 13.69 230 62 197 3019 56.6 213 18 01 F 13.69 240 66 209 3421 58.3 529 21 03 F 13.74 222 61 193 2922 54.7 321 28 02 F 13.79 221 60 188 2827 53.9 72 2 34 10 F 13.80 225 61 192 25 22 5 5.2 210 18 01 F 12.81 245 63 \u00E2\u0080\u00A2 199 3117 55.3 329 11 02 F 13.83 250 66 208 3421 57.4 368 3 02 F 13.85 224 60 189 2827 54.7 192 60 01 F 13.89 218 60 190 2827 54.8 13 65 00 F 13.90 265 71 2 24 3959 54.2 357 5 02 F 13.91 220 63 198 3117 54.5 613 70 04 F 13.57 228 65 206 3318 54,9 337 3 02 F 14.01 215 58 183 2642 54.9 625 69 04 F 14.03 231 64 203 3216 53.7 225 60 01 F 14.03 228 61 193 2922 53.2 579 44 03 F 14.05 230 63 199 3117 54.9 327 41 02 F 14.06 228 63 198 3117 55.4 372 68 02 F 14.06 220 60 189 2827 56.9 353 71 02 F 14.09 208 56 176 2463 53.8 522 21 03 F 14.12 226 60 191 2827 54.8 350 68 02 F 14.17 186 53 168 2206 52.5 235 24 01 F 14.18 223 62 195 3019 55.0 363 11 02 F 14.20 233 63 200 3117 56.2 574 1 03 F 14.25 275 69 217 3739 57,2 10 62 00 F 14.26 230 65 205 3318 53.7 355 4 02 F 14.26 236 63 198 3117 56.8 201 18 01 F 14.29 234 63 199 3117 52.9 610 70 04 F 14.30 230 62 194 3019 56.1 367 3 02 F 14.30 206 57 181 2551 54.2 205 9 01 F 14.32 235 65 205 3318 54.6 719 25 10 F 14.35 230 63 200 3117 53.0 234 18 01 F 14.41 226 60 189 2827 53.0 615 70 04 F 14.46 223 63 198 3117 52.9 345 41 02 F 14.46 230 66 207 3421 55.7 352 5 02 F 14.48 210 59 187 2733 54.0 338 11 02 F 14.51 227 64 201 3216 54.8 354 5 02 F 14.52 207 59 187 2733 53.3 332 10 02 F 14.52 256 73 231 4185 53.1 228 62 01 F 14.55 245 67 213 . 3525 53,3 8 23 CO F 14.56 248 69 219 3739 53.5 340 6 8 02 F 14.58 210 58 183 2642 54.7 C O D E R E S - R E S I - s e x A G E A R M UPPER A R M M U S C L E H E A D IMBER E R V E D E N C E ( Y R S ) C I R C D I AM C I R C A R E A C I R C \u00E2\u0080\u00A2 ( M M ) ( M M ) ( M M ) (MM**2) ( C M ) 185 60 01 F 1 4 . 6 0 223 56 179 2463 54.5 718 22 10 F 14.61 266 70 220 3848 55.7 \u00C2\u00A320 70 04 F 14.65 243 66 208 3421 55,6 580 21 03 F 14.65 243 67 213 3525 53.9 521 50 03 F 14.73 223 61 154 . 2922 53.9 724 34 10 F 14.76 275 69 217 3739 57.1 200 39 0 1 F 14. 82 246 66 207 3421 53.8 222 40 01 F 14.89 , 267 71 225 3959 58.2 622 69 04 F 14.50 242 65 206 3318 53.0 624 69 04 F 14.90 246 64 203 3216 55.0 232 60 01 F 14.91 250 65 207 3318 56.6 351 11 02 F 14.52 236 64 201 3216 56.2 216 55 01 F 14.97 255 64 203 3216 55.2 22 0 12 01 F 14.57 221 61 192 2922 56.4 336 15 02 F 15.02 220 62 194 3019 55.2 212 49 01 F 15.03 278 70 220 3848 56.3 344 3 02 F 15.C5 266 69 216 3739 57,1 173 20 01 F 1 5 . 0 . 6 240 63 199 3117 56.0 207 40 01 F 1 5 . 1 0 247 65 204 3318 55.7 728 58 10 F 15.12 214 58 185 2642 55.2 206 9 01 F 1 5 . 1 . 5 259 73 231 4185 55.0 202 38 01 F 15.18 248 67 211 3525 54,2 175 60 10 F -1 5 . 3 4 233 62 196 3019 57.0 348 41 02 F 15.35 250 62 197 3019 56.7 \u00C2\u00A381 6 03 F 15.35 269 71 223 3959 56.0 609 36 04 F 15.40 253 68 216 3631 55. 5 174 24 01 F 15.45 234 61 191 29 22 55.5 229 38 01 F 15.45 236 61 193 2922 56.6 366 73 02 F 15.4.7 256 68 214 3631 56.8 577 19 03 F 15.55 257 65 205 3318 55.4 575 16 03 F 15.55 236 67 211 3525 55.0 198 23 01 F 15.57 277 73 232 4185 55.5 359 10 C2 F 1 5 . 6 1 250 67 211 3525 52.4 349 68 02 F 15.61 239 66 207 3421 55.1 226 60 01 F 15.61 260 69 217 3 739 56.5 616 42 04 F 15.65 230 62 195 3019 55.0 371 5 02 F 15.70 207 60 188 2 827 5 3 . 6 72 6 34 10 F 1 5 . 7 . 4 202 57 181 2551 54,6 224 60 CI F 15.7 .4 235 61 194 2922 55,9 347 5 02 F 15.79 228 65 204 3318 53,8 614 70 04 F 1 5 . 8 1 263 73 229 4185 5 5 * 7 365 11 02 F 15.84 240 66 210 3421 56.8 219 60 01 F 1 5 . 8 . 8 250 66 208 3421 54.8 223 60 01 F 15.51 245 66 210 3421 55.2 358 11 02 F 16.00 238 65 205 3318 54.2 731 34 10 F 16.03 232 62 156 3015 54.0 360 5 02 F 16.04 273 70 222 3848 55.5 626 70 04 F 16.05 252 71 223 3959 52.6 5 78 57 03 F 16.05 220 60 183 2827 5 5 . 1 519 21 03 F 16.10 225 61 192 2922 55.8 365 5 02 F 1 6 . 1 . 4 . 238 68 216 3631 54.4 3 56 5 02 F 16,1.4 240 68 214 3631 52.6 362 43 02 F 16.15 266 74 232 4300 55.3 230 60 01 F 16.18 226 62 196 3019 57.0 214 27 01 F 16.18 240 67 212 3525 52.6 CODE RES- RESI- SEX AGE ARM UPPER ARM MUSCLE HEAD IMBER ERVE DENCE (YRS) CIRC DI AM CIRC AREA CIRC (MM) (MM) (MM) (MM**2) (CM) 203 38 01 F 16,22 256 68 216 3631 56.1 221 20 01 F 16,23 202 55 175 2375 54.2 725 34 10 F 16,24 233 57 182 2551 53.6 233 18 01 F 16,30 267 71 223 3959 58.6 218 56 01 F 16.33 265 73 230 4185 56.3 37C 76 02 F 16.38 236 65 207 3318 54.8 231 60 01 F 16.35 253 68 214 3631 56.2 215 18 01 F 16.47 283 74 235 4300 58.4 227 39 01 F 16.47 265 75 237 4417 55.4 21 23 00 F 16.52 267 74 234 4300 53.3 364 68 02 F 16.57 243 69 218 3739 53.9 576 57 03 F 16.55 244 63 199 3117 53.0 197 65 01 F 16.71 270 67 211 3525 55.0 612 70 04 F 16.78 271 67 212 3525 55.0 361 28 02 F 16. 85 263 71 225 3959 55.2 208 56 01 F 16.89 246 67 213 3525 56,6 584 3 3 03 F 16.51 252 68 215 3631 55.3 721 25 10 F 16.93 246 67 212 3525 56.1 209 12 01 F 16.93 258 71 223 39 59 55.9 "@en . "Thesis/Dissertation"@en . "10.14288/1.0093696"@en . "eng"@en . "Human Nutrition"@en . "Vancouver : University of British Columbia Library"@en . "University of British Columbia"@en . "For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use."@en . "Graduate"@en . "Growth of British Columbian native Indian children as assessed from anthropometric measurements"@en . "Text"@en . "http://hdl.handle.net/2429/19817"@en .