Early Human Development. 3 1 (1992) 151-162 Elsevier Scientific Publishers Ireland Ltd.
157
EHD 01351
A comparison of height, weight and head circumference of primary school children living in deprived and non-deprived circumstances C.M. Wright”, A. Aynsley-Greena, P. Tornlinsonb, L. Ahmedd and J.A. MacFarlaned “Department of Child Health, University of Newcastle upon Tyne, bDepartment of Paediatrics. Guys Hospital and ‘Department of Paediatrics, Oxford (UK) (Received
5 February
1992; revision
received
2 September
1992; accepted
2 September
1992)
Summary
Heights, weights and head circumferences were obtained from two groups of primary school children: 1016 children from throughout Oxfordshire, a rural county with few areas of deprivation, and 2 19 children from an economically deprived part of the city of Newcastle on Tyne. Compared to Tanner and Whitehouse standards, Oxfordshire children were significantly taller, but not heavier, while the Newcastle children were significantly shorter and markedly lighter. Mean head circumference values were lower in the Newcastle than the Oxfordshire children. Existing national growth standards are outdated when applied to children in acceptably advantaged circumstances while impoverished children still fall below these standards in a pattern suggestive of under nutrition. Key
words:
anthropometry;
child; growth standards; deprivation
Introduction
The school health service was established in 1907, followed by Lloyd George’s National Insurance act of 1910, in response to concerns about the poor health and puny stature of working class recruits for the Boer War. This early example of a preventative medicine response to population data is often assumed to have only historical relevance, with such discrepancies of stature long eradicated. However, Correspondence to: Charlotte M. Wright, Place, Newcastle NE2 4HH, UK.
Department
037%3782/92/$05.00 0 1992 Elsevier Scientific Printed and Published in Ireland
of Child Health,
Publishers
Ireland
The Medical School, Framlington
Ltd.
158
marked social class differentials for height and weight were still easily demonstrated in the 1000 families survey in Newcastle in 1954 [lo]. More recently, two studies in the early Eighties described social class gradients for stature in schoolchildren as incidental findings [7,9] whilst our own experience of working in school health in the late 1980s in a deprived area of Newcastle, suggested that children were still shorter than their more aflluent peers. Children measured at present are compared to the only existing British national standards for height and weight which, although to some degree re-analysed in 1976, are still derived solely from data collected in the late- 50s [ 111. In the 30 years since the Tanner and Whitehouse data were collected, a continuing secular trend to increasing adult height has been observed, commonly ascribed to increasing aflluence and improved nutrition [12], leading to suggestions that Tanner and Whitehouse standards are no longer applicable [4]. On the other hand a study of children in Leeds [3] found Tanner and Whitehouse standards to be still applicable there, although no analysis in relation to ethnic or social class breakdown was made. One explanation for these contradictory conclusions could be that while children in normal circumstances are now markedly bigger than 30 years ago, children in deprived areas still fail to reach their genetic potential, resulting in lower population means in relatively impoverished cities such as Leeds and Newcastle. In order to examine this possibility, this study compared measurements of height, weight and head circumference collected from primary school children living in Oxford and Newcastle, in very different economic circumstances and compared both data sets to Tanner and Whitehouse standards. Method During 1982-1983, as part of a study of short stature, children were sampled from schools throughout Oxfordshire at or around the age of live and a half years. Oxfordshire is mainly rural and has no major areas of deprivation. In 1987 a group of children was studied in Scotswood, a highly deprived area of Newcastle. The study population comprised all the children in the first two classes of the two primary schools in the area. Thus, the original group consisted of children predominantly living in acceptably advantaged circumstances while in the second group the children were uniformly living in an area of great deprivation. Scotswood ranks 12th for overall deprivation out of 678 wards in the Northern region with 27% unemployment and 12% of homes overcrowded [ 131. While the Oxford sample was representative of all Oxfordshire children, the Newcastle children were representative only of children living in the poorest parts of the city. In Oxford the children were measured by LA with a portable Harpenden stadiometer, spring balance and metal tape to obtain height, weight and head circumference. In Newcastle the children were measured by CMW using a fixed wall rule with a spirit level as bar, a beam balance and plastic tape. For heights, traction was applied to the mastoid processes and measurements recorded to the nearest completed millimetre in Oxford, to the nearest 2.5 mm in Newcastle. The two groups, although in the same general age range, showed a different age distribution. The Oxford children showed a normal distribution around 5.5 years
159
while the Newcastle children comprised a complete cohort between ages 4.9 and 6.9 years. Comparison between the groups and with Tanner and Whitehouse standards was made possible by deriving values corrected for age, in the form of centile bands. A computer programme placed each value in one of four centile bands, the below lOth, lo-49th, 50-89th and above 90th, using data from Tanner and Whitehouse for height and weight and the 1956 standards for head circumference. The results were compared by chi-squared analysis. Standard deviation (S.D.) scores were also calculated for height and head circumferences, but not for weight, which is not normally distributed. These scores were compared using Student’s t-test. Results One-thousand sixteen children were studied in Oxford and 219 in Newcastle. In Oxford the children were predominantly Caucasian and in Newcastle exclusively so. The most striking result was that of weight in the Newcastle children, where only 25% fell above the 50th centile, with 27% below the lOth, P < 0.001, while the Oxford children showed a weight distribution very similar to Tanner and Whitehouse (Table I). The Newcastle children were also shorter, though less markedly so, with 62% below the 50th centile and 13% below the lOth, P < 0.01. Oxford children were markedly taller than Tanner and Whitehouse, with only 36% below the 50th centile and only 4% below the lOth, P < 0.001. Head circumferences showed only a slight difference, but mean values for the Oxford children were greater than for those from Newcastle and, on comparing standard deviation scores for the two groups by t-test, the difference is significant (Table II). Discussion The findings of this study will be neither novel nor surprising to those familiar with the all pervading influence of deprivation on health. However, such observa-
TABLE I Centile band distribution of heights and weights. Centile band
Height
Weight
90th Total P-valuea
Newcastle
Oxford
Newcastle %
No.
%
21.5 47.3 19.7 5.5
60 12.3 103 40.8 43 37.3 12 9.6 218
157
EHD 01351
A comparison of height, weight and head circumference of primary school children living in deprived and non-deprived circumstances C.M. Wright”, A. Aynsley-Greena, P. Tornlinsonb, L. Ahmedd and J.A. MacFarlaned “Department of Child Health, University of Newcastle upon Tyne, bDepartment of Paediatrics. Guys Hospital and ‘Department of Paediatrics, Oxford (UK) (Received
5 February
1992; revision
received
2 September
1992; accepted
2 September
1992)
Summary
Heights, weights and head circumferences were obtained from two groups of primary school children: 1016 children from throughout Oxfordshire, a rural county with few areas of deprivation, and 2 19 children from an economically deprived part of the city of Newcastle on Tyne. Compared to Tanner and Whitehouse standards, Oxfordshire children were significantly taller, but not heavier, while the Newcastle children were significantly shorter and markedly lighter. Mean head circumference values were lower in the Newcastle than the Oxfordshire children. Existing national growth standards are outdated when applied to children in acceptably advantaged circumstances while impoverished children still fall below these standards in a pattern suggestive of under nutrition. Key
words:
anthropometry;
child; growth standards; deprivation
Introduction
The school health service was established in 1907, followed by Lloyd George’s National Insurance act of 1910, in response to concerns about the poor health and puny stature of working class recruits for the Boer War. This early example of a preventative medicine response to population data is often assumed to have only historical relevance, with such discrepancies of stature long eradicated. However, Correspondence to: Charlotte M. Wright, Place, Newcastle NE2 4HH, UK.
Department
037%3782/92/$05.00 0 1992 Elsevier Scientific Printed and Published in Ireland
of Child Health,
Publishers
Ireland
The Medical School, Framlington
Ltd.
158
marked social class differentials for height and weight were still easily demonstrated in the 1000 families survey in Newcastle in 1954 [lo]. More recently, two studies in the early Eighties described social class gradients for stature in schoolchildren as incidental findings [7,9] whilst our own experience of working in school health in the late 1980s in a deprived area of Newcastle, suggested that children were still shorter than their more aflluent peers. Children measured at present are compared to the only existing British national standards for height and weight which, although to some degree re-analysed in 1976, are still derived solely from data collected in the late- 50s [ 111. In the 30 years since the Tanner and Whitehouse data were collected, a continuing secular trend to increasing adult height has been observed, commonly ascribed to increasing aflluence and improved nutrition [12], leading to suggestions that Tanner and Whitehouse standards are no longer applicable [4]. On the other hand a study of children in Leeds [3] found Tanner and Whitehouse standards to be still applicable there, although no analysis in relation to ethnic or social class breakdown was made. One explanation for these contradictory conclusions could be that while children in normal circumstances are now markedly bigger than 30 years ago, children in deprived areas still fail to reach their genetic potential, resulting in lower population means in relatively impoverished cities such as Leeds and Newcastle. In order to examine this possibility, this study compared measurements of height, weight and head circumference collected from primary school children living in Oxford and Newcastle, in very different economic circumstances and compared both data sets to Tanner and Whitehouse standards. Method During 1982-1983, as part of a study of short stature, children were sampled from schools throughout Oxfordshire at or around the age of live and a half years. Oxfordshire is mainly rural and has no major areas of deprivation. In 1987 a group of children was studied in Scotswood, a highly deprived area of Newcastle. The study population comprised all the children in the first two classes of the two primary schools in the area. Thus, the original group consisted of children predominantly living in acceptably advantaged circumstances while in the second group the children were uniformly living in an area of great deprivation. Scotswood ranks 12th for overall deprivation out of 678 wards in the Northern region with 27% unemployment and 12% of homes overcrowded [ 131. While the Oxford sample was representative of all Oxfordshire children, the Newcastle children were representative only of children living in the poorest parts of the city. In Oxford the children were measured by LA with a portable Harpenden stadiometer, spring balance and metal tape to obtain height, weight and head circumference. In Newcastle the children were measured by CMW using a fixed wall rule with a spirit level as bar, a beam balance and plastic tape. For heights, traction was applied to the mastoid processes and measurements recorded to the nearest completed millimetre in Oxford, to the nearest 2.5 mm in Newcastle. The two groups, although in the same general age range, showed a different age distribution. The Oxford children showed a normal distribution around 5.5 years
159
while the Newcastle children comprised a complete cohort between ages 4.9 and 6.9 years. Comparison between the groups and with Tanner and Whitehouse standards was made possible by deriving values corrected for age, in the form of centile bands. A computer programme placed each value in one of four centile bands, the below lOth, lo-49th, 50-89th and above 90th, using data from Tanner and Whitehouse for height and weight and the 1956 standards for head circumference. The results were compared by chi-squared analysis. Standard deviation (S.D.) scores were also calculated for height and head circumferences, but not for weight, which is not normally distributed. These scores were compared using Student’s t-test. Results One-thousand sixteen children were studied in Oxford and 219 in Newcastle. In Oxford the children were predominantly Caucasian and in Newcastle exclusively so. The most striking result was that of weight in the Newcastle children, where only 25% fell above the 50th centile, with 27% below the lOth, P < 0.001, while the Oxford children showed a weight distribution very similar to Tanner and Whitehouse (Table I). The Newcastle children were also shorter, though less markedly so, with 62% below the 50th centile and 13% below the lOth, P < 0.01. Oxford children were markedly taller than Tanner and Whitehouse, with only 36% below the 50th centile and only 4% below the lOth, P < 0.001. Head circumferences showed only a slight difference, but mean values for the Oxford children were greater than for those from Newcastle and, on comparing standard deviation scores for the two groups by t-test, the difference is significant (Table II). Discussion The findings of this study will be neither novel nor surprising to those familiar with the all pervading influence of deprivation on health. However, such observa-
TABLE I Centile band distribution of heights and weights. Centile band
Height
Weight
90th Total P-valuea
Newcastle
Oxford
Newcastle %
No.
%
21.5 47.3 19.7 5.5
60 12.3 103 40.8 43 37.3 12 9.6 218
