Calcium intake and hypertension.

In the article "The 1982 Nobel Prize in Physiology or Medicine" (19 Nov., p. 765), the last full sentence in column 2 on page 765 should have read, "In the 1930's, Raphael Kurzrok and Charles Leib at Columbia University discovered that human seminal plasma contracted uterine smooth muscle." In the first sentence of the last paragraph in column 1 on page 768, "Calloway" should have been "Kellaway."

Fractionating healthy weight.

Any discussion of healthy weight necessarily starts with body composition and its relation to long-term mortality and morbidity and then goes on to consider the limited range of ages for which we have epidemiologic data, the time span involved, the criteria used to define "healthy," and the possibility that a weight that is advantageous with respect to one outcome criterion may be disadvantageous for another. One may therefore ask, weight of what? healthy weight for whom? by what criteria? and question whether a simple weight-for-height ratio is sufficiently effective for the task.

Relationship between birth weight and subsequent weight gain.

As shown in 8709 Black term neonates followed through 7 yr of age, there is a direct, positive relationship between birth weight and long-term weight gain. Over a 7-yr period, high-weight term Black boys and girls gain 2.6 kg more than their low-weight peers, an excess of 15%. In contrast, there is an inverse relationship between birth weight and subsequent gain in length in these term Black neonates. The long-term differential in weight gain, which is primarily attained after the first yr, has major implications for the understanding of growth and for nutritional assessment of infants and children.

Comparison of the Benn index and other body mass indices in nutritional assessment.

As shown in 58,468 individuals, representing 10 different samples from four different surveys, the "Benn" index (weight/heightp) is highly correlated with other body mass measures that use weight and height, with values of r as high as 0.98 with weight alone. Comparing the Benn index and other body mass indices with four different skinfold measurements (triceps, subscapular, iliac, and abdominal) on 1933 males and 2136 females, correlations involving the Benn (weight/heightp) index were marginally superior to those with weight (by 0.09) and only fractionally superior to those with height/weight (by 0.04). Under the circumstances it is not evident that the population-specific exponent p in the Benn index conveys a material advantage in nutritional assessment.

Reproductive histories of low weight girls and women.

As shown in 79,000 girls and women participating in four different surveys, low body weight (less than or equal to 47.2 kg) does not prevent the attainment of menarche, conception, or even repeated conceptions. Indeed, low body weight is especially common in early maturing girls and in Puerto Ricans and Mexican-Americans. From these data, the concept of a "critical weight" for menarche is difficult to substantiate, although low body weight does have nutritional implications and is the second most important factor in regulating fetal growth.

PIP: As shown in 79,000 girls and women participating in 4 different surveys, low body weight less than or equal to (47.2 kg) is without influence in preventing the attainment of menarche, conception, or even repeated conceptions. Indeed, low body weight is especially common in early maturing girls and in Puerto Ricans and Mexican Americans. From these data, the concept of a "critical weight" for menarche is difficult to substantiate, although low body weight does have nutritional implications and is the 2nd most important factor in regulating fetal growth.

Evidence against functional differences between "central" and "peripheral" fat.

As shown in 1639 men and 1851 women in the 20-49 y age range, four commonly used skinfold measurements (triceps, subscapular, iliac, and abdominal) are all highly covariant and do not show clear evidence of upper-body and lower-body or central and peripheral groupings. Moreover, the four skinfold measurements are similarly related to systolic and diastolic blood pressures and to total serum cholesterol at each decile of skinfold thickness and to a degree that strikingly parallels summed skinfold thickness (sigma sf). The changing relative contributions of the different skinfold measurements to the summed skinfold thicknesses with increasing levels of fatness also reveal no evidence of consistent anatomical or topographical groupings by body segment or distance from the body core.

Differential fatness gain of low income boys and girls.

As shown in 564 girls and 553 boys followed for a period of 18 yr, long-term gain in both subscapular and triceps skinfold thickness was higher in children of lower family income level than those of higher family incomes. This differential fatness gain accounts for the socioeconomic "reversal" of fatness in the female shown in cross-sectional studies and newly extends the phenomenon to both sexes. The finding that low-income children show a greater long-term increase in fatness bears on the prevention and control of obesity.

Maturational timing as a factor in female fatness and obesity.

As shown in more than 16 000 white participants in two major studies, menarcheal timing is a major determinant of weight and fatness in early adulthood. Early-maturing women are slightly shorter than late-maturing women but weigh 4 kg more. Early maturers are 30% fatter than late maturers, approximately +0.46 Z scores for each of four different skinfolds. Early maturers are far more often obese than late maturers (risk ratio = 1.8). The data suggest that maturational timing has a greater long-term effect on the level of fatness than the level of fatness had on maturational timing.

The bony chest breadth as a frame size standard in nutritional assessment.

As shown in 2201 males from western Scotland, the roentgenogrammetric bony chest breadth measurements provide a useful indication of frame size. Bony chest breadth is more highly correlated with weight than is true for stature. Weight corrections approximate 3.7 kg/cm of bony chest breadth and weight differences of 12 kg separate the average weight of males in the "small," "medium," and "large" bony chest breadth categories, respectively. Virtually unrelated to fatness per se, the bony chest breadth measurement provides a useful indication of fat free mass and, expressed as the weight/bony chest breadth ratio, it provides an independent estimate of relative fatness. Differences in frame size as measured by the bony chest breadth also relate to the 16-yr cardiovascular mortality.

Effect of maternal smoking on hemoglobins and hematocrits of the newborn.

PIP: The progeny of smokers had higher 48-hour hemoglobin and hematocrit levels than that of nonsmokers in this study, based on 10,399 clinically-normal term white infants. This effect could not be accounted for by 1) per capita income; 2) maternal pre-pregnancy weight or maternal stature; or 3) placental weight/birth-weight ratio, and was found to be proportionately related to the level of maternal smoking. The response of the progeny in utero to maternal smoking during pregnancy clearly is an increase in 1) red cell volume suggesting oxygen deprivation during gestation, and 2) hemoglobin concentration; consequently the progeny are likely to enter the postnatal period with a larger fetal iron reserve. This result is considered nutritionally relevant.^ieng

Income matched black-white hemoglobin differences after correction for low transferrin saturations.

As shown in 3321 age-matched pairs of black and white participants in the National Health and Nutrition Examination Surveys (NHANES I) the magnitude of difference in hemoglobin approximates 0.73 g/dl both before and after exclusion of low transferrin saturation values (i.e., equal to or less than 15%). These new income-matched, age-matched comparisons of individuals of the same sex provide a useful estimate of the magnitude of the hemoglobin difference between American blacks and whites.

Suggested sex and age appropriate values for "low" and "deficient" hemoglobin levels.

New values for "deficient" and "low" Hb have been calculated as the smoothed 5th and the 15th percentiles for white males and females included in the National Health and Nutrition Examination Survey (NHANES I). With separate tabulations for 18.389 white individuals contained in this data base and for 12,320 with transferrin saturation values of 16% and above, these new values have the advantage of being fully age-specific, based upon a single source of hematological data and providing quantitative definitions of "low" and "deficient."

Educational level, fatness, and fatness differences between husbands and wives.

In 1017 husband-wife pairs aged 20-49 y, both fatness and weight of the wives is inversely and linearly related to educational level whereas the husbands' summed skinfold measurements bear a curvilinear, parabolic relationship to years of schooling. Overall, fatness differences between husbands and wives diminish with increased education, and beyond 13 y of education husbands often exceed the subcutaneous fat thickness of their wives. When the education of one spouse is held constant at 9-12 y, women who marry up to men of greater education are systematically leaner and women who mary down are both fatter and heavier. These findings in spouse pairs sharing a common family income suggest that assortative mating with respect to educational level accounts for much of the socioeconomic effect in fatness including the fatness differences between women who marry down and those who marry up. These data also demonstrate that women are not fatter than men at all socioeconomic levels.

Fatness and obesity of the parents of obese individuals.

As shown in 1419 pairings of obese probands with their parents drawn from a larger series of greater than 9000 proband-parent pairings, the fathers and mothers of obese probands are of increased fatness level (+0.27 Z scores) and more often obese than expected (odds ratio 1.50 overall). However, the tendency towards increased fatness and a greater prevalence of obesity among the parents of obese probands bears a curvilinear relationship to the age of the proband, being least when the probands are young, peaking when the sons and daughters are teen-agers, and declining thereafter. Parents of lean probands in turn tend to be lean themselves (averaging -0.25 Z scores) and least often obese when their progeny are teen-aged. As shown in a two-generational context, familial obesity is best demonstrated in adolescents and their parents, either reflecting years spent in common or a specific etiology for adolescent-onset obesity.

Level of education, level of income, and level of fatness in adults.

Socioeconomic status is systematically related to the level of fatness, and therefore the incidence of obesity, in a total community survey of nearly 5,000 adults. Among males with more than 12 years of schooling, the average thickness of 4 fatfolds is 10% greater, amounting to about 2 kg of total fat, than those with 8 years or less of education. In females, however, the opposite trend is observed, those in the higher educational group averaging 20% thinner fatfolds, or about 5.5 kg total fat, than females in the lower educational group. These findings confirm the need for standards of obesity that take socioeconomic status into account.

Effect of remaining family members on fatness prediction.

As shown first by stepwise multiple correlations and then by family "sets" the probability that a parent or a child will be obese is a direct function of the fatness level of remaining family members. For a four-member nuclear family the probability that one member will be obese is well below chance expectancy (i.e., 12.6%) if the remaining three members are all lean and far higher (i.e., 40.7%) if the remaining family members are all obese. While mothers follow family line fatness expectancy, there is an excess of obese mothers in lean nuclear families, consistent with the inverse relationship between adult female fatness and socioeconomic status.

Fatness and mortality in the West of Scotland.

Sixteen-yr mortality data for 2381 males between the ages of 45 to 75 from the West of Scotland show that the lean rather than the obese have a higher mortality rate. However, analyzed by cause of death, it is seen that lean individuals show an excess of cancer-related deaths while obese individuals show excess cardiovascular mortality. Comparing smoking and nonsmoking males, the deleterious effects of smoking are clearly demonstrable at all fatness levels. Since obese males have a higher cardiovascular mortality and lean males show an excess of cancer-related deaths, the notion of a single "ideal weight" may be challenged.

The effect of age, sex, race, and economic status on dental caries experience of the permanent dentition. Committee to Review the Ten-State Nutrition Survey of 1968-1970.

The Ten-State Nutrition Survey data show a consistent, dramatic, and meaningful difference in dental caries experience between black and white children at all ages. This difference transcends socioeconomic grouping, nutritional level, and developmental status. This study also has shown an apparently protective effect of poverty insofar as dental caries is concerned. Children from lower-income families experienced less dental caries than children from higher-income families.

Applications of the pattern variability index (sigma z) to the quantification of dysmorphogenesis in the hand.

We have generated percentiles for the pattern variability index (sigma z) of the hand in 1,088 normal infants, children, and adults and have analyzed pattern variability indices for 820 individuals representing 50 congenital malformation syndromes with respect to the normal percentiles. The majority of the affected individuals exhibited elevated sigma z values for the hand, some vastly in excess of normal, while such syndromes as Down, Turner, and the Prader-Willi syndrome were low rather than high in pattern variability of the hand.

Carpo-metacarpal growth disturbance and the assessment of carpal narrowing in children with juvenile rheumatoid arthritis.

Second metacarpal length (M2), radio-metacarpal length (RM), and intermetacarpal width (W) were measured on 96 radiographs in 52 children with polyarticular juvenile rheumatoid arthritis (JRA), and compared with body height and skeletal maturation in order to: (1) differentiate between processes resulting in retardation of bone growth and those producing delay in skeletal maturation; (2) assess the severity and progression over time of such retardation; and (3) assess the impact of retardation of the second metacarpal on the assessment of carpal narrowing in children with JRA. All measurements were converted into z scores (the units of standard deviation above or below the normal mean for each measurement) based on published norms. Retardation of M2 (mean z scores -0.91) began earlier and was more severe compared with retardation of height (mean z score -0.25). This disproportion widened with increasing duration of disease. That this primarily represents a disturbance in M2 growth rather than a secondary effect due to altered maturation is suggested by the bone ages being normal (mean z score 0.14) and the absence of premature closure of the metacarpal physes. Z scores for RM/W (mean -3.53) were at least 1 Z more negative than for corresponding measurements of RM/M2 (mean -2.41) in 47 (90.4%) children and the mean difference between the z scores for RM/W was -1.12. This discrepancy between RM/W and RM/M2 was eliminated by correcting for the reduction in M2.