Birth weight and body composition in 6-to-8 years old Maya children.

OBJECTIVE: To test the hypothesis that fetal growth, indexed by birth weight (BW), induce metabolic adjustments in the fetus that will be reflected in differences in body composition in a sample of 6-to 8-years old urban Maya children from Yucatan, Mexico. METHODS: We measured height (cm), weight (kg) and triceps skinfold (mm) in 260 children (boys: 132, girls: 128), and height (cm) and weight (kg) in their mothers. Body composition was estimated in children through bioelectrical impedance analysis. Outcome variables were fat free-mass index (FFMI = fat-free mass [kg]/height [m]2 ) and fat mass index (FMI = fat mass [kg]/height [m]2 ). The main independent variable was BW z-scores. Multiple linear regression models were used to analyze the association between BW z-scores and outcome variables measured during childhood. Separate analyses were done for boys and girls. Complementary models were run using outcomes as z-scores. Models were adjusted for location, children's and mothers' age, mother's body mass index and household overcrowding index. RESULTS: BW in boys was positively associated with FFMI and FMI. FFMI increase 0.34 kg/m2 per 1-SD increase in BW and FMI increase 0.40 kg/m2 per 1-SD increase in BW. When outcomes were used as z-scores, FFMI increase 0.24 SD and FMI increase 0.18 SD per 1-SD increase in BW, respectively. CONCLUSION: Our results are in contrast with previous findings that birth weight is more consistently associated with subsequent lean mass than with fat mass. Associations, detected only in boys, may be explained by sex differences in sensitivity to early life environments.

The timing of adrenarche in Maya girls, Merida, Mexico.

BACKGROUND: Adrenarche involves maturation of the hypothalamic-pituitary-adrenal axis and increased production of dehydroepiandrosterone and its sulfate ester, dehydroepiandrosterone-sulfate (DHEA-S). It occurs at ages 6 to 8 in industrialized populations, marking the transition from childhood to juvenility and cognitive development at middle childhood. Studies in subsistence level populations indicate a later age (8-9) for adrenarche, but only two such studies currently exist for comparison. AIMS: To investigate adrenarcheal age among Maya girls and its association with body composition and dietary variables. We hypothesized adrenarche would occur earlier given the current dual burden of nutrition in Mexico. MATERIALS AND METHODS: 25 Maya girls aged 7 to 9 from Merida, Mexico using ELISAs to measure salivary DHEA-S, standard anthropometry for height, weight, and skinfolds, bioelectrical impedance for body composition variables, as well as a food frequency questionnaire for dietary information. RESULTS: Our hypothesis was rejected-adrenarche occurred close to 9 years. While no measures of body composition were significantly associated with adrenarcheal status, girls eating meat and dairy products more frequently had significantly higher DHEA-S levels. DISCUSSION: Like other populations living in ecologically challenging environments, adrenarche occurred relatively late among Maya girls. Adrenarche has been linked to measures of body composition, particularly, the adiposity or body mass index rebound, but no relevant anthropometric measures were associated, possibly because of the small sample. CONCLUSION: Further studies are required to illuminate how adrenarcheal variation relates to developmental plasticity, body composition, pubertal progression, and animal product consumption in other transitional populations.

Caesarean birth and adiposity parameters in 6- to 8-year-old urban Maya children from two cities of Yucatan, Mexico.

OBJECTIVES: The purpose of this study was to analyze the association between birth mode and fat mass index (FMI = fat mass [kg]/height [m]2 ), and z-score values of waist circumference (WCZ) and sum of triceps and subscapular skinfolds (SumSkfZ) in a sample of 256 6- to 8-year-old urban Maya children from the cities of Merida and Motul in Yucatan, Mexico. METHODS: From September 2011 to January 2014, we measured height, weight, waist circumference and skinfolds in children, and height and weight in their mothers. Body composition was estimated in both generations through bioelectrical impedance analysis. Data on children's birth mode and birth weight were obtained from birth certificates. A pre-validated questionnaire for mothers was used regarding household living conditions. Multiple regression models were used to analyze the association between birth mode and adiposity parameters, adjusting for the effect of place of residence, household crowding index, children's birth weight, and maternal fat mass. Separate regression models were run for boys and girls. RESULTS: Caesarean-born children comprised 43% of the entire sample. Caesarean section (CS) was found to be associated with higher values of body adiposity in girls, but not in boys. Specifically, our models predicted that girls born by CS had an increased value of 0.817 kg/m2 in FMI and showed higher SDs values for WCZ and SumskfZ (0.29 and 0.32 SD, respectively) than girls who were delivered vaginally. DISCUSSION: Our results support the hypothesis that CS is associated with increased levels of adiposity in childhood, but only in girls.

Body proportionality and adiposity are not related in 6- to 8-year-old Yucatec Maya children.

OBJECTIVE: The aim of this study was to analyze the association between relative leg length (RLL) (leg length × 100/height) and adiposity in a sample of 6- to 8-year-old children of Maya ancestry from Motul and Merida, Mexico. METHODS: This cross-sectional study included 260 children (128 girls) measured between 2011 and 2015. The RLL was used as a measure of body proportionality. Linear regression models were performed to examine the association between RLL (predictor) and three adiposity indicators (outcome variables): fat mass index (kg/m2 ), waist circumference (z-score), and sum of triceps and subscapular skinfolds (z-score). RESULTS: The prevalence of stunting was 12%, and a higher prevalence (19%) of short RLL (leg stunting) was found. The prevalence of overweight and obesity were 16% and 20%, respectively, but the highest prevalence was found for abdominal obesity (40%). None of the adiposity indicators were related to RLL (P > .05), even after adjusting for the influence of children's sex and age. CONCLUSIONS: Our results suggest that the coexistence of short RLL and high body adiposity is not observed in all populations. Our findings do not discount the possibility that a negative association between RLL and adiposity is expressed at older ages.

Living conditions and change in age of menarche in adult Maya mothers and daughters from Yucatan, Mexico.

OBJECTIVES: To analyze whether living conditions, experienced by mothers and adult daughters during their childhood, are associated with age at menarche (AAM) in daughters. METHODS: From September, 2011, to January, 2014, AAM and childhood living conditions were collected from a sample of 246 dyads of Maya mothers (mean age = 59.60 years, SD = 8.64) and their adult daughters (mean age = 33.03 years, SD = 5.57) from the cities of Merida and Motul in Yucatan, Mexico. Indicators of childhood living conditions were number of siblings and quality of house construction materials in both generations, and father's absence among daughters in their pre-menarcheal years. Multiple regression models were used to assess the association between childhood conditions in mother-daughter dyads and daughter's AAM. RESULTS: The recalled mean AAM of adult Maya daughters was 12.05 years (SD = 1.53). After adjusting for the influence of mothers' AAM, number of siblings in both the mothers' and daughters' families directly predicted daughters' AAM (more siblings was associated with a later AAM); and a higher (better) index of household conditions in mothers' childhood was associated with earlier AAM in daughters. The household conditions index during the childhood of daughters and father's absence were not associated with their AAM. CONCLUSIONS: Our results suggest that better living conditions experienced by the mothers and daughters during their childhood may lower mean AAM in daughters in the context of populations that show important intergenerational changes in their social and economic conditions.

Intergenerational changes in knee height among Maya mothers and their adult daughters from Merida, Mexico.

OBJECTIVES: To analyze differences in knee height (KH) between adult Maya mothers and daughters in Merida City, Mexico, and determine if these differences are associated with their childhood socioeconomic conditions. METHODS: From September 2011 to January 2014, we measured KH and collected data on childhood conditions (place of birth, type of drinking water, family size, and fathers' occupation) from a sample of 180 Maya mother-daughter dyads. Mean KH intergenerational difference was calculated and compared for each category of socioeconomic variables and a multiple regression model was used to assess the association between childhood conditions and KH difference. RESULTS: A relative increase of 1.05 cm (SD = 2.3 cm) or 0.45 standard deviations (effect size of difference) was observed in KH between generations. Place of birth was significantly associated with KH. With three other variables statistically adjusted for, the intergenerational KH difference was 1.5 cm greater when mothers were born outside Merida but daughters were born in the city. Piped water consumption by mother-daughter dyads was associated with 1.5 cm of increase in KH difference compared with dyads who consumed well water (P = 0.058). CONCLUSIONS: The relative increase in KH between mothers and daughters represents a portion of the expected change in growth in a group that has experienced few substantial improvements in their living conditions. Some improvements in childhood living conditions resulting from the intergenerational transition from rural to urban environments seem to be linked to a modest, but statistically significant intergenerational increase in KH among Maya women in Merida.

Intergenerational influences on the growth of Maya children: The effect of living conditions experienced by mothers and maternal grandmothers during their childhood.

OBJECTIVES: To test the hypothesis that living conditions experienced by maternal grandmothers (F1 generation) and mothers (F2 generation) during their childhood are related to height and leg length (LL: height - sitting height) of their 6-to-8 year old children (F3 generation). METHODS: From September 2011 to June 2012 we obtained height and LL, and calculated z-score values of these measurements for 109 triads (F1 , F2 , F3 ) who are Maya living in Merida, Yucatan, Mexico. Multiple regression models were adjusted to examine the relation of anthropometric and intergenerational socioeconomic parameters of F1 (house index and family size during childhood) and F2 (paternal job loss during childhood) with the z-score values of height and LL of F3 . RESULTS: Children's height and LL were positively associated with maternal height and LL. This association was relatively stronger in LL. Better categories of grand-maternal house index were significantly associated with higher values of height and LL in grandchildren. Grand-maternal family size was positively related with LL, but not with height. CONCLUSIONS: Our findings partially support the hypothesis that living conditions experienced by recent maternal ancestors (F1 and F2 ) during their growth period influence the growth of descendants (F3 ). Results suggest that LL is more sensitive to intergenerational influences than is total height and that the transition from a traditional rural lifestyle to urban conditions results in new exposures for risk in human physical growth.

Nutritional status of Maya children, their mothers, and their grandmothers residing in the City of Merida, Mexico: revisiting the leg-length hypothesis.

OBJECTIVES: To test the hypothesis that leg length-relative-to-stature is a more sensitive indicator of nutrition and health than is total height (HT) or sitting height (SH) in a sample of 109 triads of urban Maya children (6.0-8.99 years), their mothers, and maternal grandmothers from Merida, Mexico. METHODS: From September 2011 to June 2012, the following factors were obtained from all participants: (1) HT, SH, and leg length (LL); (2) the sitting height ratio (SHR = [SH × 100]/HT), relative leg length index (RLLI = [LL × 100]/height), and percentiles and z-scores of HT, SH, and LL were calculated; and (3) the percentages of stunting for children or very short ZHT for the adults, short ZSH, and short ZLL: HT-for-age, SH-for-age, or LL-for-age below the 5th percentile of the reference were calculated. Correlations were performed to examine the association between z-scores of HT, SH, and LL among three generations. RESULTS: Stunting in children was 11% (short ZLL = 29%, short ZSH = 7%). Short ZHT was present in 71% of mothers (short ZLL = 54%, short ZSH = 50%) and 90% of grandmothers (short ZLL = 69%, short ZSH = 83%). Significant correlations in ZHT, ZSH, and ZLL were found in mother-to-child and grandmother-to-mother, with the strongest correlations for ZLL. CONCLUSIONS: These findings support the hypothesis for children and mothers. Based on ZLL, there is evidence that childhood and nutrition have improved somewhat for each younger generation. Persistent environmental adversity during growth resulted in growth deficits for LL and SH for the mothers and grandmothers.

Dietetic characteristics of a sample of Mayan dual burden households in Merida, Yucatan, Mexico.

The Maya are the most populous and shortest in stature Native American ethnic group. The Maya provide us a good opportunity to study the dietetic characteristics of a group who experience nutritional dual burden (the combination of under and ovenutrition) at the individual, mother-child dyad and population level. The aim of this study is to describe general dietetic patterns of a sample of Maya mothers and children who experienced nutritional dual burden and were living in the city of Merida, Yucatan, Mexico. From February to July 2010 we applied food frequency questionnaires (FFQ) to 58 dyads of Maya mothers and their children (7-9 years old). The FFQ was developed by staff of the Department of Human Ecology at Cinvestav and included 78 foods, grouped in: cereals and tubers, foods of animal origin, leguminous vegetables, fats, fruits, vegetables, sugars, and daily products. The frequencies of consumption were classified in four levels: 1) no consumption, 2) low (1-2 days/week), 3) medium (3-4 days/week), high (5-7 days/week). The observed pattern suggests a low consumption of fruits and vegetables, a medium consumption of pork, eggs, oil and lard, and a high consumption of soda and whole milk. From these frequencies we extrapolated that the dietetic pattern is characterized by a low intake of fibre and micronutrients and high intake of fat and sugars, findings supported by previous National and regional studies. Our observations suggest that the studied group have a dietetic pattern that has moved away from a traditional Maya diet.

Fat free mass explains the relationship between stunting and energy expenditure in urban Mexican Maya children.

BACKGROUND: Childhood stunting has been associated with an increased risk of obesity in adulthood, but the causes are unclear. This study hypothesizes that stunting significantly reduces both resting and activity energy expenditure. AIM: To assess and describe energy expenditure of low socio-economic Maya children and to determine whether stunting is independently related to energy expenditure after controlling for lean mass. SUBJECTS AND METHODS: Thirty-three urban Maya children, 17 boys, aged 7-9 years, living in Merida, Mexico, were measured for height, weight and bioelectrical impedance analysis (BIA). Body composition was estimated from BIA. Energy expenditure was measured for one week using the Actiheart (combined heart rate and accelerometer). RESULTS: Stunting (height-for-age below the 5(th) percentile of NHANES III based references) affected 35% of these physically active children. Using multiple linear regression analysis, greater lean body mass predicted higher resting and activity energy expenditure. Stature was not a significant predictor of resting energy expenditure. A lower height-for-age z-score, but not stunting as a categorical variable, significantly predicted lower activity energy expenditure. CONCLUSION: The hypothesis that stunting reduces total energy expenditure (resting + active) in children is not supported. Rather, children with shorter stature and less lean body mass have lower total energy expenditure. Complex interactions between body size, body composition, and metabolic activity appear to elevate the risk for later life obesity in these Maya children.

The nutritional dual-burden in developing countries--how is it assessed and what are the health implications?

This paper focuses on the phenomenon of the nutritional dual-burden in the developing world. Nutritional dual-burden is defined as the coexistence of under-and-over nutrition in the same population/group, the same household/family, or the same person. In this paper we aim: a) to describe the different types of nutritional dual-burden, b) to identify the anthropometric indicators generally used to classify the nutritional dual-burden, c) to focus our attention on a dual-burden group (the Maya from Merida, Yucatan, Mexico), d) to illustrate problems in the categorization of the dual-burden, and e) to suggest possible health implications. Our results show that, for our sample, the prevalence of individual dual-burden among children is very low, but is very high among the mothers and for mother-child pairs (household dual-burden). Most importantly, the criteria used to assess the nutritional status of the individuals and of the families will play an important role in the estimated prevalence of nutritional dual-burden, and this will have practical impacts for health intervention programs.

Logistics of using the Actiheart physical activity monitors in urban Mexico among 7- to 9-year-old children.

Logistics of using new measurement devices are important to understand when developing protocols. This paper discusses the logistics of using Actiheart physical activity monitors on children in an urban, tropical environment in a developing country. Actiheart monitoring of 36 children aged 7-9 years old was undertaken for 7 days in the city of Mérida, Yucatán, Mexico. The Actiheart proved fragile for children and difficult to mend in the field. The excessive sweating due to the tropical climate caused poor adherence of the electrode pads, requiring a pad change midway through and extra pads to be provided. Also extra time was needed to be allotted for increased instructions to participants and their mothers and for individual calibration. When collecting objectively measured physical activity data under harsh conditions, the protocol must accommodate local conditions and device limitations and allow increased time with participants to obtain good quality data.

How useful is BMI in predicting adiposity indicators in a sample of Maya children and women with high levels of stunting?

OBJECTIVES: Body mass index (BMI) is used frequently to estimate adiposity levels in children and adults. However, the applicability of BMI to populations with high levels of stunting has been questioned. Stunted people can have disproportionately short legs, which may increase BMI without increasing body fat because of the relatively larger trunk compared with the legs. METHODS: A sample of 57 urban Maya schoolchildren, aged 7-9 years (31 boys), and 53 adult women underwent anthropometric assessments and bioelectrical impedance analysis. Multiple linear regression was performed to determine whether the ability of BMI to predict adiposity indicators is altered by stunting and sitting height ratio (SHR). The adiposity indicators were waist circumference, sum of skinfolds, upper arm muscle area, upper arm fat area, and arm fat index. RESULTS: BMI was the strongest predictor of all adiposity indicators and in most cases, explained more of the variance in adiposity of Maya children than Maya women. Abdominal adiposity was better predicted by BMI than peripheral adiposity in Maya women and Maya children. Stunting was significant in predicting adiposity in some models but never substantially changed the variance explained. SHR was never a significant predictor. CONCLUSIONS: The relationship between BMI and adiposity indicators is not changed by stunting status or body proportions in this short population of urban Maya children and women. BMI can be used as an indicator of adiposity for these children but not the women. It is recommended that BMI is used in conjunction with other estimates of body composition.

Maternal Grandmothers' Household Residency, Children's Growth, and Body Composition Are Not Related in Urban Maya Families from Yucatan.

This study analyzes the influence of grandmothers' household residency on the presence of low height-for-age and excessive fat (FMI = fat mass [kg]/height [m2]), waist circumference, and sum of triceps and subscapular skinfolds in a sample of 247 6- to 8-year-old urban Maya children from Yucatan, Mexico. Between September 2011 and January 2014, we obtained anthropometric and body composition data from children and mothers, as well as socioeconomic characteristics of participants and households. Grandmothers' place of residence was categorized as either in the same household as their grandchildren (n = 71) or in separate households (n = 176). Multiple logistic regression models were used to analyze the association between grandmothers' residency and outcome variables. Models were adjusted for maternal anthropometric characteristics and the following socioeconomic variables: family size, location, maternal education, monthly family income, and household crowding. Models showed that the presence of grandmothers in their grandchildren's households was not associated with any of the outcome variables. In contrast, larger family size, overcrowding in the household, and lower family income predicted low height-for-age in children. Larger family size decreased the risk for being overweight based on the three parameters of body composition. Overcrowding in the household increased the risk for greater skinfolds thickness, while low family income increased the risk for higher fat mass index. The residency of grandmothers in their adult daughters' households is not significantly associated with the outcome variables in this sample of urban Maya families. Instead, maternal anthropometric characteristics and socioeconomic conditions of the family have a greater influence on the overall growth of children.

Growth and nutritional status of Portuguese children from Lisbon, and their parents. Notes on time trends between 1971 and 2001.

AIM: To document time trends in growth and nutritional status among Portuguese children from Lisbon, and their parents. SUBJECTS AND METHODS: Two growth surveys were carried out in Lisbon, Portugal in 1991 and in 2001 at the request of the Municipality of Lisbon. The 1991 sample was composed of 2018 children (992 boys and 1026 girls) and the 2001 sample was composed of 3591 children (1787 boys and 1804 girls). The ages range from 4 to 11 years. The data from these surveys is compared with published data from 1971. Data on growth and nutritional status of the children and their parents were analysed. Nutritional status of the family clusters is also documented. RESULTS: There was an increase in the average height of the children between 1971 and 2001, but a more severe increase in overweight and obesity. Stunting in height was virtually non-existent among the children, but leg stunting (leg length relative to height) was high. The main changes between 1991 and 2001 are towards a greater prevalence of overweight/obese family clusters and dual-burden family clusters (at least one underweight member and one overweight/obese member). CONCLUSIONS: In this biological survey article we present two growth databases that may be used in future studies. There is an urgent need to conduct a national growth survey in Portugal, including all age groups, with stratified samples by district and ethnic diversity.

Height and relative leg length as indicators of the quality of the environment among Mozambican juveniles and adolescents.

The growth status of Mozambique adolescents was assessed to test the hypothesis that relative leg length is a more sensitive indicator of the quality of the environment than the total height. The sample comprised 690 boys and 727 girls, aged between 9 and 17 years, from Maputo. It is divided between those living in the Centre of Maputo and those living in the slums on the periphery of the city. Height, weight, and sitting height were measured and the sitting height ratio was calculated. The hypothesis that relative leg length is more sensitive than total stature as an indicator of environmental quality is not uniformly confirmed. Overall, mean stature is greater for the centre group than the slum group, but relative leg length as measured by the sitting height ratio does not differ. Compared with African-American references (NHANES II), all centre girls, 9- to 14-year-old slum girls, all slum boys, and the oldest centre boys show relatively shorter legs. These findings show that within the Mozambique sample, relative leg length is not sensitive enough to distinguish the quality of the living environment. Mozambique was a colony of Portugal until 1975. Civil unrest and warfare characterized the late Colonial period and the postindependence period until a peace settlement was concluded in 1992. It is possible that all socioeconomic status groups within the country suffered sufficiently to reduce relative leg length compared with the better-off African-American reference sample. Possible genetic influences on relative leg length are also discussed.

Influence of maternal stature, pregnancy age, and infant birth weight on growth during childhood in Yucatan, Mexico: a test of the intergenerational effects hypothesis.

In developing nations, obesity has increased dramatically in the last decade, but a high prevalence of stunting still coexists. The intergenerational influences hypothesis (IIH) is one explanation for this. We test the IIH regarding variation in maternal stature, mother's age at pregnancy, and infant birth weight in relation to risk for overweight and stunting in 206 Maya children (4-6 years old) from Mérida, Yucatan, Mexico. The Maya children are compared with growth references (Frisancho 2008: Anthropometric Standards: An Interactive Nutritional Reference of Body Size and Body Composition for Children and Adults. Ann Arbor, MI: The University of Michigan Press. 335 pp) for height, weight, and body mass index (BMI). Almost 70% of the mothers are shorter than 150 cm. Mothers' height and child's birth weight predict overweight. Children with a mother shorter than 150 cm are less than half as likely (OR = 0.44) to be overweight compared to children whose mothers are equal to or taller than 150 cm. Children with birth weights below 3,000 g are only a third as likely to be overweight (OR = 0.28) than their peers within the range of normal birth weight (3,000-3,500 g). Sex of the child, mother's height, and birth weight predict stunting. Girls are only 40% as likely as boys to be stunted. Children with a mother below 150 cm are 3.6 times more likely of being stunted. Children with birth weights below 3000 g are over 3 times more likely to be stunted relative to children with birth weights within the normal range. Mother's age at pregnancy is not a predictor of overweight or stunting. Our findings conform the IIH and with similar studies of populations undergoing nutritional/epidemiological transitions from traditional to globalized lifestyles.

Body Mass Index in Mother and Child Dyads and its Association With Household Size and Parents' Education in 2 Urban Settings of Yucatan, Mexico.

BACKGROUND: Overweight/obesity (OW/OB) coexists in mother-child dyads. However, a dearth of evidence on the factors associated with this phenomenon calls for research. OBJECTIVE: To analyze the association of sociodemographic factors with OW/OB in a sample of 260 Maya mother-child dyads from Yucatan, Mexico. METHODS: During 2011 to 2014, we measured height and weight in children and their mothers and calculated their body mass index (BMI). The OW/OB cutoff points were defined, for mothers, as having a BMI >25 kg/m2 and, for children, as having a BMI-for-age >2 standard deviation of the World Health Organization references. Mother-child dyads were grouped according to their BMI status: (1) normal weight mother and child, (2) normal weight mother and OW/OB child, (3) OW/OB mother and normal weight child, and (4) OW/OB mother and child. A multinomial logistic regression model was used to analyze the interrelationships among BMI status in mother-child dyads, household size, and parental education. RESULTS: Overweight/obesity coexisted in 40% of dyads. Compared to normal weight dyads (1), each unit increase in household size and in years of maternal education decreased the risks of the coexistence of OW/OB in mother-child dyads (odds ratio [OR] = 0.72, 95% confidence interval [CI] 0.55-0.94, P = .015; OR = 0.70, 95% CI 0.52-0.94, P = .019, respectively). Conversely, each year increase in paternal education increased the risk for OW/OB in dyads (OR = 1.47, 95% CI 1.08-1.99, P = .015). CONCLUSIONS: Results suggest that household size and parental education contribute to shape BMI-based nutritional status in this sample of mother-child dyads.

Behavioral, environmental, metabolic and intergenerational components of early life undernutrition leading to later obesity in developing nations and in minority groups in the U.S.A.

Nutritional transition, urbanization, and physical inactivity are primary factors responsible for the worldwide epidemic of overweight/obesity (OW/OB). However, these factors fail to explain the epidemic of OW/OB in developing countries and in recent-migrants to developed countries. Among these, OW/OB is associated with short/stunted stature and coexists with undernutrition at much higher rates than is statistically expected. Changes in metabolic pathways toward reduced fat oxidation and increased metabolism of carbohydrate may explain, in part, this phenomenon. Also, intergenerational consequences of malnutrition and poor health of the mothers may lead to impaired phenotypes in their offspring. We propose a novel methodology to assess the history of early life malnutrition by assessing the sitting height ratio of the mothers. The degree of "short leggedness" reflects undernutrition when the mother was an infant/child. Collectively, behavioral, environmental, metabolic and intergenerational components of early life undernutrition may provide a more satisfactory explanation for later life obesity.