Nutrition in adolescent growth and development

During adolescence, growth and development are transformative and have profound consequences on an individual's health in later life, as well as the health of any potential children. The current generation of adolescents is growing up at a time of unprecedented change in food environments, whereby nutritional problems of micronutrient deficiency and food insecurity persist, and overweight and obesity are burgeoning. In a context of pervasive policy neglect, research on nutrition during adolescence specifically has been underinvested, compared with such research in other age groups, which has inhibited the development of adolescent-responsive nutritional policies. One consequence has been the absence of an integrated perspective on adolescent growth and development, and the role that nutrition plays. Through late childhood and early adolescence, nutrition has a formative role in the timing and pattern of puberty, with consequences for adult height, muscle, and fat mass accrual, as well as risk of non-communicable diseases in later life. Nutritional effects in adolescent development extend beyond musculoskeletal growth, to cardiorespiratory fitness, neurodevelopment, and immunity. High rates of early adolescent pregnancy in many countries continue to jeopardise the growth and nutrition of female adolescents, with consequences that extend to the next generation. Adolescence is a nutrition-sensitive phase for growth, in which the benefits of good nutrition extend to many other physiological systems.

Advancing human health in the decade ahead: pregnancy as a key window for discovery: A Burroughs Wellcome Fund Pregnancy Think Tank

Recent revolutionary advances at the intersection of medicine, omics, data sciences, computing, epidemiology, and related technologies inspire us to ponder their impact on health. Their potential impact is particularly germane to the biology of pregnancy and perinatal medicine, where limited improvement in health outcomes for women and children has remained a global challenge. We assembled a group of experts to establish a Pregnancy Think Tank to discuss a broad spectrum of major gestational disorders and adverse pregnancy outcomes that affect maternal-infant lifelong health and should serve as targets for leveraging the many recent advances. This report reflects avenues for future effects that hold great potential in 3 major areas: developmental genomics, including the application of methodologies designed to bridge genotypes, physiology, and diseases, addressing vexing questions in early human development; gestational physiology, from immune tolerance to growth and the timing of parturition; and personalized and population medicine, focusing on amalgamating health record data and deep phenotypes to create broad knowledge that can be integrated into healthcare systems and drive discovery to address pregnancy-related disease and promote general health. We propose a series of questions reflecting development, systems biology, diseases, clinical approaches and tools, and population health, and a call for scientific action. Clearly, transdisciplinary science must advance and accelerate to address adverse pregnancy outcomes. Disciplines not traditionally involved in the reproductive sciences, such as computer science, engineering, mathematics, and pharmacology, should be engaged at the study design phase to optimize the information gathered and to identify and further evaluate potentially actionable therapeutic targets. Information sources should include noninvasive personalized sensors and monitors, alongside instructive "liquid biopsies" for noninvasive pregnancy assessment. Future research should also address the diversity of human cohorts in terms of geography, racial and ethnic distributions, and social and health disparities. Modern technologies, for both data-gathering and data-analyzing, make this possible at a scale that was previously unachievable. Finally, the psychosocial and economic environment in which pregnancy takes place must be considered to promote the health and wellness of communities worldwide.

Comparison of physical examination and laboratory data between a clinical study and electronic health records

Research based on secondary analysis of data stored in electronic health records (EHR) has gained popularity, but whether the data are consistent with those collected under a study setting is unknown. The objective is to assess the agreement between data obtained in a prospective study and routine-care data extracted retrospectively from the EHR. We compared the data collected in a longitudinal lifestyle intervention study with those recorded in the EHR system over 5 years. A total of 225 working adults were recruited at an academic institution between 2008–2012, whose EHR data were also available during the same time period. After aligning the participants’ study visit dates with their hospital encounter dates, data on blood pressure, body mass index (BMI), and laboratory measurements (including high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides, and total cholesterol) were compared via a paired t-test for equivalence with pre-specified margins. Summary statistics were used to compare smoking status and medication prescriptions. Overall, data were consistent between the two sources (i.e., BMI, smoking status, medication prescriptions), whereas some differences were found in cholesterol measurements (i.e., HDL and total cholesterol), possibly due to different lab assays and subject’s fasting status. In conclusion, some EHR data are fairly consistent with those collected in a clinical study, whereas others may require further examination. Researchers should evaluate the consistency and quality of EHR data and compare them with other sources of data when possible.

Promoting Healthy Growth or Feeding Obesity? The Need for Evidence-Based Oversight of Infant Nutritional Supplement Claims

The Developmental Origins of Health and Disease (DOHaD) model recognizes growth in infancy and childhood as a fundamental determinant of lifespan health. Evidence of long-term health risks among small neonates who subsequently grow rapidly poses a challenge for interventions aiming to support healthy growth, not merely drive weight gain. Defining healthy growth beyond "getting bigger" is essential as infant and young child feeding industries expand. Liquid-based nutritional supplements, originally formulated for undernourished children, are increasingly marketed for and consumed by children generally. Clarifying the nature of the evidentiary base on which structure/function claims promoting "healthy growth" are constructed is important to curb invalid generalizations. Evidence points to changing social beliefs and cultural practices surrounding supplementary feeding, raising specific concerns about the long-term health consequences of an associated altered feeding culture, including reduced dietary variety and weight gain. Reassessing the evidence for and relevance of dietary supplements' "promoting healthy growth" claims for otherwise healthy children is both needed in a time of global obesity and an opportunity to refine intervention approaches among small children for whom rapid subsequent growth in early life augments risk for chronic disease. Scientific and health care partnerships are needed to consider current governmental oversight shortfalls in protecting vulnerable populations from overconsumption. This is important because we may be doing more harm than good.

Effects of a Health-Partner Intervention on Cardiovascular Risk

BACKGROUND

Lifestyle modifications are first-line measures for cardiovascular disease prevention. Whether lifestyle intervention also preserves cardiovascular health is less clear. Our study examined the role of a Health Partner-administered lifestyle intervention on metrics of ideal cardiovascular health.

METHODS AND RESULTS

A total of 711 university employees (48±11 years; 66% women, 72% Caucasian/22.5% African Americans) enrolled in a program that promoted healthier lifestyles at Emory University (Atlanta, GA). Anthropometric, laboratory, and physical activity measurements were performed at baseline and at 6 months, 1 year, and 2 years of follow-up. Results were utilized by the Health Partner to generate a personalized plan aimed at meeting ideal health metrics. Compared to baseline, at each of the 6-month, 1-year, and 2-year follow-up visits, systolic blood pressure was lower by 3.6, 4.6, and 3.3 mm Hg (P<0.001), total cholesterol decreased by 5.3, 6.5, and 6.4 mg/dL (P<0.001), body mass index declined by 0.33, 0.45, and 0.38 kg/m² (P<0.001), and the percentage of smokers decreased by 1.3%, 3.5%, and 3.5% (P<0.01), respectively. Changes were greater in those with greater abnormalities at baseline. Finally, the American Heart Association "Life's Simple 7" ideal cardiovascular health score increased by 0.28, 0.40, and 0.33 at 6 month, 1 year, and 2 years, respectively, compared to baseline visit.

CONCLUSIONS

A personalized, goal-directed Health Partner intervention significantly improved the cardiometabolic risk profile and metrics of cardiovascular health. These effects were evident at 6 months following enrollment and were sustained for 2 years. Whether the Health Partner intervention improves long-term morbidity and mortality and is cost-effective needs further investigation.

Trajectories of body mass index amongst children who develop type 2 diabetes as adults

OBJECTIVE

Type 2 diabetes (T2D) is a heterogeneous disorder. The aim of this study was to examine the trajectories of childhood growth associated with T2D.

DESIGN AND SUBJECTS

A total of 13 345 individuals born in Helsinki, Finland between 1934 and 1944 were included in the study. The participants' growth had been recorded in detail during childhood, and 11.7% (n = 1558) had been diagnosed with T2D. We divided the cohort around the median body mass index (BMI) at 11 years. Body composition and glucose tolerance were assessed in a clinical subsample (n = 2003) in adulthood.

RESULTS

Two pathways of growth were associated with T2D. Both began with low weight and BMI at birth. In one, persistent low BMI through infancy was followed by a rapid increase in BMI in childhood. Amongst individuals with a BMI at 11 years above the median value, the odds ratio for T2D associated with a one z-score increase in BMI between 2 and 11 years was 1.31 (95% confidence interval 1.21-1.42, P < 0.001). In the other pathway, low BMI at birth, accompanied by short length at birth, was followed by low BMI in childhood. Most women who developed diabetes followed this trajectory; they developed T2D at a lower BMI and lower fat percentage than women with a BMI above the median at 11 years of age.

CONCLUSIONS

Two pathways of early growth trigger T2D. Low fat deposition leading to thinness at birth and during infancy results in fat acquisition during childhood. Reduced linear growth leading to short length at birth is associated with lower body fat percentage in adulthood but increased risk of developing diabetes.

Engaging young adults in proactive health behaviors: a goal-setting process

The Human Health Program at Emory University, Atlanta, Georgia, is an undergraduate curriculum that focuses on health in its broadest context, exploring novel strategies that educate, engage, empower, and encourage college students to develop and sustain healthy lifestyle behaviors. In the program, students take part in a onesemester experience that is a blend of academic health education and wellness coaching, where the group class supports a self-directed health goal process.

Small head circumference at birth and early age at adiposity rebound

AIMS

The adiposity rebound is the age in childhood when body mass index is at a minimum before increasing again. The age at rebound is highly variable. An early age is associated with increased obesity in later childhood and adult life. We have reported that an early rebound is predicted by low weight gain between birth and 1 year of age and resulting low body mass index at 1 year. Here, we examine whether age at adiposity rebound is determined by influences during infancy or is a consequence of foetal growth. Our hypothesis was that measurements of body size at birth are related to age at adiposity rebound.

METHODS

Longitudinal study of 2877 children born in Helsinki, Finland, during 1934-1944.

RESULTS

Early age at adiposity rebound was associated with small head circumference and biparietal diameter at birth, but not with other measurements of body size at birth. The mean age at adiposity rebound rose from 5.8 years in babies with a head circumference of ≤33 cm to 6.2 in babies with a head circumference of >36 cm (P for trend = 0.007). The association between thinness in infancy and early rebound became apparent at 6 months of age. It was not associated with adverse living conditions. In a simultaneous regression, small head circumference at birth, high mother's body mass index and tall maternal stature each had statistically significant trends with early adiposity rebound (P = 0.002, <0.001, 0.004).

CONCLUSION

We hypothesize that the small head size at birth that preceded an early adiposity rebound was the result of inability to sustain a rapid intra-uterine growth trajectory initiated in association with large maternal body size. This was followed by catch-up growth in infancy, and we hypothesize that this depleted the infant's fat stores.

Prenatal and postnatal energetic conditions and sex steroids levels across the first year of life

OBJECTIVES

Human biologists have documented variability in reproductive maturation, fertility, and cancer risk related to developmental conditions. Yet no previous studies have directly examined the impact of prenatal and postnatal energetic environments on sex steroids in infancy, a critical period for hypothalamic-pituitary-gonadal axis development. Thus, we examined the impact of maternal characteristics, birth size, and feeding practices on fecal sex steroid production in a longitudinal sample of 31 American infants followed from 2 weeks to 12 months of age.

METHODS

Maternal characteristics and birth size were collected at study enrollment, infant diet was assessed through weekly 24-h food diaries, and anthropometrics were measured weekly. Fecal estradiol and testosterone levels were assessed weekly using validated microassay RIA techniques. Mixed models were used to test for associations between maternal and birth characteristics, feeding practices, and sex steroids across the first year of life. Formal mediation analysis examined whether the relationship between infant feeding and hormone levels was mediated by infant size.

RESULTS

Maternal and birth characteristics had persistent effects on fecal sex steroid levels, with taller maternal height and larger birth size associated with lower estradiol levels in girls and higher testosterone levels in boys. Infant diet was also associated with sex steroid levels independently of infant size. Formula feeding was associated with higher estradiol levels in boys and girls and with higher testosterone in girls.

CONCLUSION

These results suggest that markers of early energy availability influence sex hormone levels with potential long-term consequences for reproductive development and function.

Markers of biological fitness as predictors of all-cause mortality

INTRODUCTION

Within the Helsinki Birth Cohort, men who were tall when they were 7 years old lived for 5 years longer than men who were short. In the present analyses we examined two other influences known to be associated with lifespan: having children and educational attainment. We hypothesized that tall stature, the ability to have children, and high educational attainment reflect three aspects of biological fitness that are acquired during development.

METHODS

We examined all-cause mortality in 6975 men and 6370 women born in Helsinki during 1934-1944, whose childhood growth, number of children, and educational attainment were recorded.

RESULTS

In contrast to men, tall stature in childhood was not associated with longer lifespan among women. Men and women who had children lived for longer than those who had no children. Among women, having children was only associated with increased lifespan among those whose body mass index increased between 2 and 11 years. High educational attainment was associated with longer lifespan in both sexes. The trends of lower all-cause mortality with higher educational attainment were present in each socio-economic group. The men and women who had children, and attained upper tertiary education, lived for 16 years longer than those who had no children and only basic education.

CONCLUSION

We suggest that the associations between having children, educational attainment, and lifespan reflect two different aspects of biological fitness that are acquired during early development.

Ethnic differences in the accumulation of fat and lean mass in late gestation

OBJECTIVES

Lower birth weight within the normal range predicts adult chronic diseases, but the same birth weight in different ethnic groups may reflect different patterns of tissue development. Neonatal body composition was investigated among non-Hispanic Caucasians and African Americans, taking advantage of variability in gestational duration to understand growth during late gestation.

METHODS

Air displacement plethysmography assessed fat and lean body mass among 220 non-Hispanic Caucasian and 93 non-Hispanic African American neonates. The two ethnic groups were compared using linear regression.

RESULTS

At 36 weeks of gestation, the average lean mass of Caucasian neonates was 2,515 g vs. that of 2,319 g of African American neonates (difference, P = 0.02). The corresponding figures for fat mass were 231 and 278 g, respectively (difference, P = 0.24). At 41 weeks, the Caucasians were 319 g heavier in lean body mass (P < 0.001) but were also 123 g heavier in fat mass (P = 0.001). The slopes for lean mass vs. gestational week were similar, but the slope of fat mass was 5.8 times greater (P = 0.009) for Caucasian (41.0 g/week) than for African American neonates (7.0 g/week).

CONCLUSIONS

By 36 weeks of gestation, the African American fetus developed similar fat mass and less lean mass compared with the Caucasian fetus. Thereafter, changes in lean mass among the African American fetus with increasing gestational age at birth were similar to the Caucasian fetus, but fat accumulated more slowly. We hypothesize that different ethnic fetal growth strategies involving body composition may contribute to ethnic health disparities in later life.

Resource allocation in utero and health in later life

The way that a fetus obtains and allocates nutritional resources has profound consequences for its life-long health. Under the new developmental model for the origins of chronic disease, the causes to be identified are linked to normal variations in the processes of feto-placental development, that are associated with differences in the supply of nutrients to the baby. These differences programme the function of a few key systems that are linked to chronic disease, including the immune system, anti-oxidant defences, inflammation, and the number and quality of stem cells. There is not a separate cause for each different disease. Which chronic disease originates during development may depend more on timing than on qualitative differences in experience.

Menopause, A Biocultural Perspective

Each menopausal body is the product of decades of physiological responses to an environment composed of cultural and biological factors. Anthropologists have documented population differences in reproductive endocrinology and developmental trajectories, and ethnic differences in hormones and symptoms at menopause demonstrate that this stage of life history is not exempt from this pattern. Antagonistic pleiotropy, in the form of constraints on the reproductive system, may explain the phenomenon of menopause in humans, optimizing the hormonal environment for reproduction earlier in the life course. Some menopausal symptoms may be side effects of modernizing lifestyle changes, representing discordance between our current lifestyles and genetic heritage. Further exploration of women's experience of menopause, as opposed to researcher-imposed definitions; macro- and microenvironmental factors, including diet and intestinal ecology; and folk etiologies involving the autonomic nervous system may lead to a deeper understanding of the complex biocultural mechanisms of menopause.

Measurement of testosterone in infant fecal samples

OBJECTIVES

This study reports the validation of a noninvasive method for repeated assessment of testosterone from infant fecal samples.

METHODS

Fecal samples were collected from cotton diaper liners, subjected to methanol extraction, and assayed using a modified commercial testosterone RIA kit.

RESULTS

Method validity was supported by a recovery near 100%, a sensitivity of 1.23 pg/ml, and inter- and intra-assay coefficients of variations less than 10 and 15%, respectively. Testosterone was detected in all samples from male and female infants aged 2 weeks to 15 months.

CONCLUSIONS

Fecal assessment is supported as a novel, non-invasive tool for studying testosterone during early human development.

Infant head circumference growth is saltatory and coupled to length growth

BACKGROUND

Rapid growth rates of head circumference and body size during infancy have been reported to predict developmental pathologies that emerge during childhood.

AIMS

This study investigated whether growth in head circumference was concordant with growth in body length.

SUBJECTS

Forty infants (16 males) were followed between the ages of 2 days and 21 months for durations ranging from 4 to 21 months (2616 measurements).

STUDY DESIGN

Longitudinal anthropometric measurements were assessed weekly (n=12), semi-weekly (n=24) and daily (n=4) during home visits. Individual head circumference growth was investigated for the presence of saltatory patterns. Coincident analysis tested the null hypothesis that head growth was randomly coupled to length growth.

RESULTS

Head circumference growth during infancy is saltatory (p<0.05), characterized by median increments of 0.20 cm (95% confidence interval, 0.10-0.30 cm) in 24-h, separated by intervals of no growth ranging from 1 to 21 days. Daily assessments identified that head growth saltations were coupled to length growth saltations within a median time frame of 2 days (interquartile 0-4, range 1-8 days). Assessed at semi-weekly and weekly intervals, an average 82% (SD 0.13) of head growth saltations was non-randomly concordant with length growth (p≤0.006).

CONCLUSIONS

Normal infant head circumference grows by intermittent, episodic saltations that are temporally coupled to growth in total body length by a process of integrated physiology that remains to be described.

Infant growth in length follows prolonged sleep and increased naps

STUDY OBJECTIVES

The mechanisms underlying infant sleep irregularity are unknown. This study tests the hypothesis that sleep and episodic (saltatory) growth in infant length are temporally coupled processes.

STUDY DESIGN

Daily parental diaries continuously recorded sleep onset and awakening for 23 infants (14 females) over 4-17 months (n = 5798 daily records). Multiple model-independent methods compared day-to-day sleep patterns and saltatory length growth.

MEASUREMENTS AND RESULTS

Approximate entropy (ApEn) quantified temporal irregularity in infant sleep patterns; breastfeeding and infant sex explained 44% of inter-individual variance (P = 0.001). Random effects mixed-model regression identified that saltatory length growth was associated with increased total daily sleep hours (P < 0.001) and number of sleep bouts (P = 0.001), with breastfeeding, infant sex, and age as covariates. Infant size and illness onset were non-contributory. CLUSTER analysis identified peaks in individual sleep of 4.5 more h and/or 3 more naps per day, compared to intervening intervals, that were non-randomly concordant with saltatory length growth for all individuals (P < 0.05), with a time lag of 0-4 days. Subject-specific probabilities of a growth saltation associated with sleep included a median odds ratio of 1.20 for each additional hour (n = 8, 95% CI 1.15 to 1.29) and 1.43 for each additional sleep bout (n = 12, 95% CI 1.21-2.03). Increased sleep bout duration predicted weight (P < 0.001) and abdominal skinfold accrual (P = 0.05) contingent on length growth, and truncal adiposity independent of growth (P < 0.001).

CONCLUSIONS

Sleeping and length growth are temporally related biological processes, suggesting an integrated anabolic system. Infant behavioral state changes may reflect biological mechanisms underlying the timing and control of human growth.

Non-invasive methods for estradiol recovery from infant fecal samples

While the activation of the infant hypothalamic-pituitary-gonadal axis and the existence of a postnatal gonadotropin surge were first documented in the early 1970s, study of the longitudinal development of gonadal hormones in infancy, and the potential physiological and behavioral correlates of this development, have been hampered by reliance on infrequent serum sampling. The present study reports the validation of a non-invasive method for repeated assessment of steroid hormones in infant fecal samples. Fecal samples were collected in and excised from cotton diaper liners and extracted using methanol. Extracts were analyzed for estradiol using a diluted assay modification. Method validity was supported by a steroid recovery rate of at least 80%, a sensitivity of 0.35 pg/ml, and inter- and intra-assay coefficients of variations of less than 10 and 20%, respectively. Variation in estradiol concentration was assessed across (1) sample type (scraped vs. cut from diaper liner), (2) time of day (morning vs. afternoon/evening samples), (3) time interval between samples, and (4) time-to-assay (1 day vs. 489 days after collection). Of these characteristics, only the time interval between samples within an individual was significantly associated with estradiol concentration. This is the first report of human infant fecal estradiol levels. The results support fecal recovery as a novel and powerful non-invasive tool for longitudinal studies of human infants, expanding research opportunities for investigating development of sex-specific behaviors in infancy, and the potential effects of endocrine disruptors on development.

Sex differences in fetal growth responses to maternal height and weight

Sex differences in fetal growth have been reported, but how this happens remains to be described. It is unknown if fetal growth rates, a reflection of genetic and environmental factors, express sexually dimorphic sensitivity to the mother herself. This analysis investigated homogeneity of male and female growth responses to maternal height and weight. The study sample included 3,495 uncomplicated singleton pregnancies followed longitudinally. Analytic models regressed fetal and neonatal weight on tertiles of maternal height and weight, and modification by sex was investigated (n = 1,814 males, n = 1,681 females) with birth gestational age, maternal parity, and smoking as covariates. Sex modified the effects of maternal height and weight on fetal growth rates and birth weight. Among boys, tallest maternal height influenced fetal weight growth before 18 gestational weeks of age (P = 0.006), and prepregnancy maternal weight and body mass index subsequently had influence (P < 0.001); this was not found among girls. Additionally, interaction terms between sex, maternal height, and maternal weight identified that males were more sensitive to maternal weight among shorter mothers (P = 0.003) and more responsive to maternal height among lighter mothers (P < or = 0.03), compared to females. Likewise, neonatal birth weight dimorphism varied by maternal phenotype. A male advantage of 60 g occurred among neonates of the shortest and lightest mothers (P = 0.08), compared to 150 and 191 g among short and heavy mothers, and tall and light-weight mothers, respectively (P = 0.01). Sex differences in response to maternal size are under-appreciated sources of variation in fetal growth studies and may reflect differential growth strategies.

Growth perturbations in a phenotype with rapid fetal growth preceding preterm labor and term birth

The variability in fetal growth rates and gestation duration in humans is not well understood. Of interest are women presenting with an episode of preterm labor and subsequently delivering a term neonate, who is small relative to peers of similar gestational age. To further understand these relationships, fetal growth patterns predating an episode of preterm labor were investigated. Retrospective analysis of fetal biometry assessed by serial ultrasound in a prospectively studied sample of pregnancies in Santiago, Chile, tested the hypothesis that fetal growth patterns among uncomplicated pregnancies (n = 3,706) and those with an episode of preterm labor followed by term delivery (n = 184) were identical across the time intervals 16-22 weeks, 22-28 weeks, and 28-34 weeks in a multilevel mixed-effects regression. The hypothesis was not supported. Fetal weight growth rate was faster from 16 weeks among pregnancies with an episode of preterm labor (P < 0.05), declined across midgestation (22-28 weeks, P < 0.05), and rebounded between 28 and 34 weeks (P = 0.06). This was associated with perturbations in abdominal circumference growth and proportionately larger biparietal diameter from 22 gestational weeks (P = 0.03), greater femur (P = 0.01), biparietal diameter (P = 0.001) and head circumference (P = 0.02) dimensions relative to abdominal circumference across midgestation (22-28 weeks), followed by proportionately smaller femur diaphyseal length (P = 0.02) and biparietal diameter (P = 0.03) subsequently. A distinctive rapid growth phenotype characterized fetal growth preceding an episode of preterm labor among this sample of term-delivered neonates. Perturbations in abdominal circumference growth and patterns of proportionality suggest an altered growth strategy pre-dating the preterm labor episode.

Early rapid growth, early birth: accelerated fetal growth and spontaneous late preterm birth

The past two decades in the United States have seen a 24% rise in spontaneous late preterm delivery (34-36 weeks) of unknown etiology. This study tested the hypothesis that fetal growth was identical prior to spontaneous preterm (n = 221, median gestational age at birth 35.6 weeks) and term (n = 3706) birth among pregnancies followed longitudinally in Santiago, Chile. The hypothesis was not supported: Preterm-delivered fetuses were significantly larger than their term-delivered peers by mid-second trimester in estimated fetal weight, head, limb, and abdominal dimensions, and they followed different growth trajectories. Piecewise regression assessed time-specific differences in growth rates at 4-week intervals from 16 weeks. Estimated fetal weight and abdominal circumference growth rates slowed at 20 weeks among the preterm-delivered, only to match and/or exceed their term-delivered peers at 24-28 weeks. After an abrupt growth rate decline at 28 weeks, fetuses delivered preterm did so at greater population-specific sex and age-adjusted birth weight percentiles than their peers from uncomplicated pregnancies (P < 0.01). Growth rates predicted birth timing: one standard score of estimated fetal weight increased the odds ratio for late preterm birth from 2.8 prior to 23 weeks, to 3.6 (95% confidence interval, 1.82-7.11, P < 0.05) between 23 and 27 weeks. After 27 weeks, increasing size was protective (OR: 0.56, 95% confidence interval, 0.38-0.82, P = 0.003). These data document, for the first time, a distinctive fetal growth pattern across gestation preceding spontaneous late preterm birth, identify the importance of mid-gestation for alterations in fetal growth, and add perspective on human fetal biological variability.

Downward percentile crossing as an indicator of an adverse prenatal environment

BACKGROUND

Postnatal health sequelae of low birth weight have been attributed to 'poor fetal growth' from inferred adverse prenatal environments; risks augmented by infant growth rates. Identifying prenatal growth-restricting events is essential to clarify pathways and mechanisms of fetal growth.

AIM

The specific aim of this investigation was to examine whether an episode of preterm labor may compromise fetal growth.

SUBJECTS AND METHODS

Fetal size at the end of the second trimester and birth were compared among women with uncomplicated pregnancies (n = 3167) and those who experienced an episode of preterm labor (<37 weeks) and subsequently delivered at term (> or =37 weeks, n = 147). Fetal weight estimated from ultrasound measures, and changes in weight standard scores across the third trimester investigated significant centile crossing (>0.67 standard deviation score change).

RESULTS

Fetuses delivered at term after an episode of preterm labor were smaller at birth relative to their peers than at the end of the second trimester, and were 47% more likely to experience clinically significant downward centile crossing (p < 0.05) than their peers (OR 1.47, 95% CI 1.04-2.07).

CONCLUSION

An episode of preterm labor may signal an adverse prenatal environment for term-delivered neonates. Epidemiologically silent events in the natural history of pregnancy are an understudied source of fetal growth compromise as inferred by small birth size among peers.

Growth chart curves do not describe individual growth biology

Growth reference tables present statistical distributions of size for age of individuals within a sample or population. As summaries of phenotypic variability at the group level, they document that individuals grow by different rates during similar time frames. The data are commonly fitted by mathematical functions to produce the convex curves of percentile distributions useful for infant and childhood growth monitoring. In this form, the growth chart appears to be a frame of reference for judging how well an individual infant/child is progressing through time by comparison with peers across ages. This has led to the assumption that individuals should track in these channels during growth. The interpolated lines between the statistical distributions of size for age at the level of the population do not, however, represent how individuals grow. Growing is an individual process characterized by nonlinear episodic saltatory increments that result in shifting size relationships among similarly aged peers over short time intervals. Data from a prospective, longitudinal study of infants illustrate the poor performance of growth chart curves as representations of individual growth. Clarification of the paradigms supporting perceptions of normal growth patterns is useful both practically and theoretically: growth chart patterns have important clinical sequelae when this informs feeding recommendations. Further characterization of individual growth patterns will contribute to increased understanding of both individual growth biology and the nature of adaptability.

Parents' assessment of risk in sickle cell disease treatment with hydroxyurea

Hydroxyurea is the only medication shown to reduce the severity of sickle cell disease (SCD), but its long-term risks are unknown. Families of 58 children with SCD were interviewed on their perception of the potential risks of hydroxyurea treatment, and whether disease severity was a major factor in their treatment decision. Parents rated the severity of their child's SCD (86% as severe, 26% moderate, and 47% mild) and then the highest levels of risk that they would tolerate for both potential cancer (range 1/1,000 to 1/2) and potential birth defects (range 1/1,000 to 1/3) to benefit their child with hypothetical hydroxyurea treatment. Parents of 29 of the 58 children were unwilling to take any cancer risk whatsoever as a potential side effect of treatment, and 29 of 58 (not all the same parents) were unwilling to take any risk for birth defects, including half the children with severe SCD. For those families who did accept some risk, higher acceptable risk correlated with higher disease severity in the child (P = 0.04). The study's mixed findings highlight the complexities of risk perception and suggest that future studies of risks and benefits from the parental viewpoint are needed as candidate therapies are developed for SCD.

Sex differences in the relationships among weight gain, subcutaneous skinfold tissue and saltatory length growth spurts in infancy

As the mechanisms controlling the amount and timing of growth saltations are not well understood, the identification of physiologic coupling in weight and length growth are important for further understanding normal growth biology. Thirty-four healthy infants (13 males, 21 females) participated in a longitudinal growth study during the first year. Weekly weights and s.c. skinfolds (limb and trunk) were analyzed in a growth event-focused study. Coincident analysis tested the null hypothesis of chance concurrence between significant weight gain and saltatory length growth spurts. Logistic regression quantified this relationship and investigated the interaction between incremental weight gain and s.c. skinfolds on length growth spurts. The null hypothesis of random coincidence between weight gain and saltatory length growth was not supported. For girls, significant weight gain and length growth were coupled during the same week and length saltations were 42% more likely during the weeks of significant weight gain, with no interaction from s.c. skinfolds. For boys, length growth saltations were coupled to both previous and concomitant weight gain but were predicted only by previous weight gain, controlling for confounders. Boys were 68% more likely to grow in length the week following significant weight gain, and initial abdominal to suprailiac skinfold ratios conferred a 4-fold increased likelihood of length growth within the week, controlling for confounders. These data generate the hypothesis that a common growth signal cascade couples growth in weight and length/height with a time delay due to sex-specific biology, reflected in a s.c. fat fold interface.

Growing pains: are they due to increased growth during recumbency as documented in a lamb model?

The rate and patterns of longitudinal bone growth are affected by many different local and systemic factors; however, uncompromised growth is usually considered to be smoothly continuous, with predictable accelerations and decelerations over periods of months to years. The authors used implanted microtransducers to document bone growth in immature lambs. Bone length measurements were sampled every 167 seconds for 21 to 25 days. The authors show that at least 90% of bone elongation occurs during recumbency and almost no growth occurs during standing or locomotion. The authors hypothesize that growth may also occur in children during rest or sleep, thus supporting the concept of nocturnal growth and perhaps a relationship to growing pains.

Growth patterns of the heart and kidney suggest inter-organ collaboration in facultative fetal growth

Maternal smoking during pregnancy has been associated with a number of negative sequelae among offspring, including elevated postnatal blood pressure. While animal studies have described organ level alterations with smoke exposure, human data have been more limited. Thirty-four healthy maternal/fetal pairs (24 nonsmokers, 10 smokers) participated in a longitudinal growth study from the thirteenth week of pregnancy to document fetal kidney and heart growth trajectories and morphology. Curve fitting followed by a mixed model for repeated measures identified significantly different growth patterns in kidney width, thickness, length, and volume growth with exposure: the smoke-exposed fetal kidney was wide and thick compared to the unexposed kidney during the second and early third trimester, declining to proportionately thin kidneys for length and width subsequently. Cardiac growth in width and volume followed a reverse pattern: a surge in cardiac volume occurred after 30 weeks with acceleration in cardiac width, resulting in a heart that was wide for length and for fetal weight. Smoke exposure altered fetal growth in size and timing of the heart and kidneys during midgestation, with changes in organ morphology suggesting compensatory growth. These are the first data providing anatomical evidence of altered renal/cardiac volume relationships that may provide a mechanism to previously reported sequelae of in utero smoke exposure. They suggest that cell-level adaptive responses to hypoxia and/or chemical insults are operative and illustrate the importance of longitudinal ultrasound to directly assess the organ-level growth response of the human fetus to a prenatal stress, in lieu of relying on birth outcome measures.

Exposure to maternal diabetes is associated with altered fetal growth patterns: A hypothesis regarding metabolic allocation to growth under hyperglycemic-hypoxemic conditions

The prevalence of diabetes is rising worldwide, including women who grew poorly in early life, presenting intergenerational health problems for their offspring. It is well documented that fetuses exposed to maternal diabetes during pregnancy experience both macrosomia and poor growth outcomes in birth size. Less is known about the in utero growth patterns that precede these risk factor expressions. Fetal growth patterns and the effects of clinical class and glycemic control were investigated in 37 diabetic pregnant women and their fetuses and compared to 29 nondiabetic, nonsmoking maternal/fetal pairs who were participants in a biweekly longitudinal ultrasound study with measurements of the head, limb, and trunk dimensions. White clinical class of the diabetic women was recorded (A2-FR) and glycosylated hemoglobin levels taken at the time of measurement assessed glycemic control (median 6.9%, interquartile range 5.6-9.2%). No significant difference in fetal weight was found by exposure. The exposed sample had greater abdominal circumferences from 21 weeks (P < or = 0.05) and shorter legs, but greater upper arm and thigh circumferences accompanied increasing glycemia in the second trimester. In the third trimester, exposed fetuses had a smaller slope for the occipital frontal diameter (P = 0.00) and were brachycephalic. They experienced a proximal/distal growth gradient in limb proportionality with higher humerus / femur ratios (P = 0.04) and arms relatively long by comparison with legs (P = 0.02). HbA1c levels above 7.5% accompanied shorter femur length for thigh circumference after 30 gestational weeks of age. Significant effects of diabetic clinical class and glycemic control were identified in growth rate timing. These growth patterns suggest that hypoxemic and hyperglycemic signals cross-talk with their target receptors in a developmentally regulated, hierarchical sequence. The increase in fetal fat often documented with diabetic pregnancy may reflect altered growth at the level of cell differentiation and proximate mechanisms controlling body composition. These data suggest that the maternal-fetal interchange circuit, designed to share and capture resources on the fetal side, may not have had a long evolutionary history of overabundance as a selective force, and modern health problems drive postnatal sequelae that become exacerbated by increasing longevity.

Cellular life histories and bow tie biology

Considering the life-long influences of fetal growth biology, it is of interest to further elucidate the nature of the fetal growth process itself. Previous analyses of longitudinal fetal ultrasound data led to the hypothesis that hypoxia signals were important aspects of normal growth biology and directed attention to the place of oxygen as a basic nutrient. From the perspective of the cell, both hypoxia and lack of energy substrate trigger a common adaptive pathway through their effects on ATP availability. Comparative data from animal studies and cell culture provide evidence for an integrated energy/oxygen signaling system that acts redundantly and hierarchically with cellular differentiation programs, providing opportunities for developmental flexibility in response to variable ecologic or environmental challenge. The multinodal and interactive design of the fetal growth process suggests that it follows what has been described as the "bow tie" model of metabolism, with implications for robust and inventive approaches to cell, organ, and whole organism construction.

Timing is everything: a reconsideration of fetal growth velocity patterns identifies the importance of individual and sex differences

Fetal growth has been posited to follow a "timing hypothesis" sequence in which the second trimester favors a single growth velocity peak in body length and the third trimester accommodates a single growth velocity peak in weight accrual. To our knowledge, this proposition has never been tested with high-frequency longitudinal ultrasound data from normally growing human fetuses. The present study examined whether fetal growth in leg length had its peak velocity at or about 20-26 gestational weeks and declined subsequently and whether estimated fetal weight velocity was maximal at or about 33 weeks and declined subsequently; if the greatest acquisition of leg length occurred in the second trimester and weight in the third trimester; and if birth outcomes reflected these relationships. The data in this study included approximately weekly longitudinal ultrasound data collected from 44 maternal/fetal pairs in Brussels, Belgium. Diaphyseal lengths of the femur and tibia provided information on leg growth and estimated fetal weight was assessed from the biparietal and occipital-frontal head diameters and transverse and anterior-posterior diameters of the abdomen. Growth patterns were investigated from individual growth curves derived from daily growth velocity z-scores. Paired t-tests compared individuals' trimestral increments in leg length and fetal weight. Least-squares regression models employing the robust procedure for repeated measurements were used to test for relationships between trimester, size, growth rates, and birth outcome, controlling for day of measurement, sex, maternal smoking, and gestational age at birth. The normal fetuses in this study grew by pulsatile patterns of leg and estimated weight acquisition, not a single peak and decline process. Greater incremental growth in estimated fetal weight occurred during the second trimester and leg length in the third trimester. Individual and sex effects were significant in growth velocity patterns. Girls grew with greater synchrony between leg and weight growth and were accelerated by comparison with boys, with faster leg growth predicting lower ponderal index by the second trimester. Birth outcomes were sex-specific in timing effects and predictive variables. These results support the importance of sex-specific analyses, reemphasize the common notion that girls grow faster than boys, and direct attention to cross-talk between energy resources and growth.

Prenatal smoke exposure alters growth in limb proportions and head shape in the midgestation human fetus

The objective of this study was to examine the effects of smoke exposure on the growth patterns of the head, limbs, and torso of the midgestation human fetus. Four hundred maternal/fetal pairs contributed to this analysis: 366 individuals were assessed cross-sectionally (87 smokers and 279 nonsmokers) at approximately 20 and 32 weeks, and 34 individuals were followed longitudinally at 23, 27, and 32 weeks (10 smokers, 24 nonsmokers). Ten body parameters were measured by fetal ultrasound. In both samples, controlling for day of measurement, smoke exposure was significantly associated with early growth acceleration in head and abdominal diameters at 20-27 weeks (P < 0.05). This was followed by altered head shape (a significantly smaller biparietal to occipital frontal diameter ratio at 32 weeks, P < 0.01), and a proximal/distal growth gradient as proportionately long arms (P < 0.05 at 27 and 32 weeks) and short legs were apparent by 32 weeks, with a significant reduction in the tibia/femur ratio (P = 0.04). These fetal body growth patterns, expressed in terms of size and proportionality, are consistent with the presence of chronic hypoxia associated with maternal smoking. The growth pattern differences identify that prenatal smoking is not merely an insult resulting in consistent size and growth rate reduction across developmental ages. Instead, smoke exposure alters the growth rate of individual body segments at variable developmental stages as the fetus experiences selective growth restriction and augmentation. We hypothesize that the growth patterns observed here reflect the unique pattern of fetal blood flow favoring upper body oxygen distribution and extraction, together with genetically based adaptive strategies that permit the fetus to adjust the timing and magnitude of its growth to local environmental resources. It is possible that dolichocephaly is a previously unappreciated marker of fetal hypoxia. Reduced tibial growth may be a good marker for shortfall and a useful proxy for the adequacy of circulating resources more generally.

Infants thinner at birth exhibit smaller kidneys for their size in late gestation in a sample of fetuses with appropriate growth

Fetal ultrasound measurements were employed to investigate the relationship between weight and ponderal index at birth and kidney size during the second (23 weeks) and third (32 weeks) trimesters of pregnancy in a sample of 25 normally growing fetuses. Kidney volume and kidney volume / fetal weight ratio at 32 weeks are significantly and positively related to both weight and ponderal index at birth, controlling for sex, gestational age at birth, and day of ultrasound measurement. A second-degree polynomial relationship approximates the predictability of kidney volume fetal weight ratio at 23 weeks to that at 32 weeks, demonstrating shifting growth rates in fetal organ and body growth relationships during midgestation. Sex and parental size are suggested as contributing to these patterns. Females have a surge in renal growth between 23 and 32 weeks to catch up to earlier growing males, and maternal weight significantly predicts incremental growth in kidney volume and the kidney volume / fetal weight ratio at 32 weeks of gestation. The observation that fetuses relatively thin at birth have relatively smaller kidneys for their size in late gestation suggests that the influence of maternal weight on birth outcome may act through organ growth.

The use of regularity as estimated by approximate entropy to distinguish saltatory growth

A nonlinear dynamics metric, approximate entropy (ApEn), is investigated as a diagnostic method for distinguishing between mathematical models, and the underlying mechanistic hypotheses that purport to describe the same time series experimental observations. ApEn measures the occurrence of pattern regularity within a time series, and is used here to investigate growth patterns in daily length growth. The notion investigated is that ApEn distributions for competing time series patterns expressed as mathematical formulations can be modelled by Monte Carlo and bootstrap methods and compared to the ApEn values for an original experimental data series. If the ApEn values for the different models do not overlap, then it is expected that ApEn can be utilized to distinguish these models and hypotheses, and to provide statistical assessment for the underlying biological patterns in experimental data. The conclusion is that the ApEn metric is successful as a time series diagnostic tool. It is a model-independent statistic that clearly differentiates saltatory growth from slowly varying continuous models of growth and serves to further document the saltatory nature of growth. This is a unique application of approximate entropy, illustrating the broad applicability of ApEn to biological time series, with the specific example of discriminating a saltatory growth process in longitudinal growth data. Future investigations of regularity in longitudinal time series in human biology with ApEn statistics are suggested.

Child factor in measurement dependability

A primary consideration in longitudinal growth studies is the identification of growth from error components. While previous research has considered matters of measurement accuracy and reproducibility in detail, few reports have investigated the errors of measurement due to aspects of the physiology and cooperation of the child. The present study directly assesses this source of measurement undependability for the first time. Investigation of total measurement error variance in 925 recumbent length replicates taken over stasis intervals in growth identifies that between 60% and 70% of total measurement unreliability is due to a child factor undependability. Individual differences are significant and longitudinal growth analyses should consider two to three times the technical error of measurement statistic as a reasonable estimate of the total unreliability for any single measurement of an infant's recumbent length. These results raise issues regarding analytic methods as applied to serial growth data.

Mixed distribution analysis identifies saltation and stasis growth

A maximum likelihood method of mixed distribution analysis is investigated for its utility as a method for the identification of saltation and stasis in longitudinal growth data. Daily infant growth data that have been previously identified to follow a saltatory growth process are employed. This is a novel application of the finite mixed distribution analysis (MDA), a method designed to objectively identify the presence of one or more Gaussian populations. The null hypothesis is that a single Gaussian distribution best describes the incremental growth data. This would be compatible with smooth, slowly varying daily growth patterns. This study explores whether or not two distinctive populations are evident in incremental saltatory growth data, as postulated by the saltation and stasis observations. The analysis is important in providing a growth model-independent test for the presence of saltation and stasis by a separate statistical assessment with none of the saltatory algorithm assumptions. The finite mixed distribution analysis identifies that each individual's incremental growth data is statistically best described as a mixture consisting of two components, or two populations of increments (chi-square, p < 0.05). For each individual, one of these populations is centred about a zero increment, and is compatible with the previous evidence of stasis intervals. The second population of data points is characterized by unique distributions for each individual, compatible with the previous observation that infants grow by unique patterns of growth saltations in both amplitude and frequency. The percentage of data points that fall within each of the two unique finite mixture distributions (FMDs) is similar to the proportions of discrete saltation and stasis intervals previously identified by the saltation and stasis method. Thus, the FMD analysis lends support to the nature of growth as a saltatory process characterized by two states in the daily growth of these infants. By contrast with the saltatory algorithm, which is applied to the original serial growth measurements, the mixed distribution analysis employs increments removed from their time relationships. The lack of time series sequence information precludes the mixed distribution method from reconstructing specific temporal patterns of saltatory growth. The present analysis reiterates that individual growth patterns are statistically unique and cannot be reconstructed or identified from group data.

A novel cold-sensitive allele of the rate-limiting enzyme of fatty acid synthesis, acetyl coenzyme A carboxylase, affects the morphology of the yeast vacuole through acylation of Vac8p

The yeast vacuole functions both as a degradative organelle and as a storage depot for small molecules and ions. Vacuoles are dynamic reticular structures that appear to alternately fuse and fragment as a function of growth stage and environment. Vac8p, an armadillo repeat-containing protein, has previously been shown to function both in vacuolar inheritance and in protein targeting from the cytoplasm to the vacuole. Both myristoylation and palmitoylation of Vac8p are required for its efficient localization to the vacuolar membrane (Y.-X. Wang, N. L. Catlett, and L. S. Weisman, J. Cell Biol. 140:1063-1074, 1998). We report that mutants with conditional defects in the rate-limiting enzyme of fatty acid synthesis, acetyl coenzyme A carboxylase (ACC1), display unusually multilobed vacuoles, similar to those observed in vac8 mutant cells. This vacuolar phenotype of acc1 mutant cells was shown biochemically to be accompanied by a reduced acylation of Vac8p which was alleviated by fatty acid supplementation. Consistent with the proposed defect of acc1 mutant cells in acylation of Vac8p, vacuolar membrane localization of Vac8p was impaired upon shifting acc1 mutant cells to nonpermissive condition. The function of Vac8p in protein targeting, on the other hand, was not affected under these conditions. These observations link fatty acid synthesis and availability to direct morphological alterations of an organellar membrane.

Electrospray ionization tandem mass spectrometry (ESI-MS/MS) analysis of the lipid molecular species composition of yeast subcellular membranes reveals acyl chain-based sorting/remodeling of distinct molecular species en route to the plasma membrane

Nano-electrospray ionization tandem mass spectrometry (nano-ESI-MS/MS) was employed to determine qualitative differences in the lipid molecular species composition of a comprehensive set of organellar membranes, isolated from a single culture of Saccharomyces cerevisiae cells. Remarkable differences in the acyl chain composition of biosynthetically related phospholipid classes were observed. Acyl chain saturation was lowest in phosphatidylcholine (15.4%) and phosphatidylethanolamine (PE; 16.2%), followed by phosphatidylserine (PS; 29.4%), and highest in phosphatidylinositol (53.1%). The lipid molecular species profiles of the various membranes were generally similar, with a deviation from a calculated average profile of approximately +/- 20%. Nevertheless, clear distinctions between the molecular species profiles of different membranes were observed, suggesting that lipid sorting mechanisms are operating at the level of individual molecular species to maintain the specific lipid composition of a given membrane. Most notably, the plasma membrane is enriched in saturated species of PS and PE. The nature of the sorting mechanism that determines the lipid composition of the plasma membrane was investigated further. The accumulation of monounsaturated species of PS at the expense of diunsaturated species in the plasma membrane of wild-type cells was reversed in elo3Delta mutant cells, which synthesize C24 fatty acid-substituted sphingolipids instead of the normal C26 fatty acid-substituted species. This observation suggests that acyl chain-based sorting and/or remodeling mechanisms are operating to maintain the specific lipid molecular species composition of the yeast plasma membrane.

The Saccharomyces cerevisiae hyperrecombination mutant hpr1Delta is synthetically lethal with two conditional alleles of the acetyl coenzyme A carboxylase gene and causes a defect in nuclear export of polyadenylated RNA

In a screen for mutants that display synthetic lethal interaction with hpr1Delta, a hyperrecombination mutant of Saccharomyces cerevisiae, we have isolated a novel cold-sensitive allele of the acetyl coenzyme A (CoA) carboxylase gene, acc1(cs), encoding the rate-limiting enzyme of fatty acid synthesis. The synthetic lethal phenotype of the acc1(cs) hpr1Delta double mutant was only partially complemented by exogenous fatty acids. hpr1Delta was also synthetically lethal with a previously isolated, temperature-sensitive allele of ACC1, mtr7 (mRNA transport), indicating that the lethality of the acc1(cs) hpr1Delta double mutant was not allele specific. The basis for the interaction between conditional acc1 alleles and hpr1Delta was investigated in more detail. In the hpr1Delta mutant background, acetyl-CoA carboxylase enzyme activity was reduced about 15-fold and steady-state levels of biotinylated Acc1p and ACC1 mRNA were reduced 2-fold. The reduced Acc1p activity in hpr1Delta cells, however, did not result in an altered lipid or fatty acid composition of the mutant membranes but rendered cells hypersensitive to soraphen A, an inhibitor of Acc1p. Similar to mtr7, hpr1Delta and acc1(cs) mutant cells displayed a defect in nuclear export of polyadenylated RNA. Oversized transcripts were detected in hpr1Delta, and rRNA processing was disturbed, but pre-mRNA splicing appeared wild type. Surprisingly, the transport defect of hpr1Delta and acc1(cs) mutant cells was accompanied by an altered ring-shaped structure of the nucleolus. These observations suggest that the basis for the synthetic lethal interaction between hpr1Delta and acc1 may lie in a functional overlap of the two mutations in nuclear poly(A)+ RNA production and export that results in an altered structure of the nucleolus.

An example of variation and pattern in saltation and stasis growth dynamics

The serial data from two siblings, aged 6.6 and 7.5 years of age at the initiation of the study, measured each evening for total standing height during 365 days, are analysed by two methods to investigate the nature of the underlying growth pattern. The saltation and stasis model, designed to identify the presence of statistically significant pulses in sequential data, is compared for goodness-of-fit to first to sixth degree polynomial functions, used to investigate the presence of a slowly varying smooth continuous function in the data, and high order polynomials of the same degree of flexibility as the individual's saltation and stasis results. The saltation and stasis model is found to better-fit the experimental data than the slowly varying smooth continuous functions (p < 0.01 to 0.001). The timing characteristics of the saltation and stasis patterns are investigated and the temporal patterns are suggestive of a non-random, aperiodical deterministic system.

Wrinkles induced by the use of smoothing procedures applied to serial growth data

This paper elucidates the effects of moving average filters when applied to serial growth measurements. This is a question of interest because smoothing procedures are inherently part of a number of analytical methods presently employed in auxological analyses. Particular attention is paid to sequential growth data analysed to identify what has been described as pulsatile, saltation and stasis patterns or mini-growth spurts. When applied to pulsatile, or saltatory, time series data the process of smoothing itself creates artifactual temporal patterns in the time series data similar to previously described mini growth spurts while removing the actual pulsatile characteristics of the data. These observations illustrate that smoothing approaches add noise to time series data while removing meaningful patterns in the original data sequence. Analyses employing such approaches produce results that include waveforms or other fluctuations compatible with an underlying pulsatile driving mechanism, but do not necessarily reflect the temporal characteristics of the original biological process.