YEARBOOK OF PHYSICAL ANTHROPOLOGY 25169-179 (1982) Clinical Applications of Physical Anthropology MEINHARD ROBINOW Department of Pediatrics, Wright State University School of Medicine and the Children’s Medical Center, Dayton, Ohio 45404 KEY WORDS fitness, Sports Anthropometry, Growth, Nutrition, Dysmorphology, Physical ABSTRACT In recent decades physical anthropology has moved from its more traditional confines into many areas of clinical interest including growth and development, nutrition, clinical medicine, dysmorphology, and physical fitness. The “clinical applications” of physical anthropology is a broad topic, given the space limitations of a review. Hence, selected clinical applications, emphasizing anthropometry at the expense of physiology and genetics, are considered. Since the author is a pediatrician, the review concentrates largely on areas dealing with children. In the nineteenth century, physical anthropologists were largely limited to a few measuring tools: anthropometer, weighing scales, calipers and measuring tapes, and were handicapped by somewhat primitive statistics. Modern workers have enlarged their inventory of measuring tools, improved their methodology, and greatly refined the statistical treatment of data. Earlier physical anthropologists concentrated on a rather limited group of study areas: (1)the dimensions of the human body and their variation with age, sex and race, and, to a lesser extent, with occupation and social class; (2) prehistory and human evolution; (3) taxonomy of human races; and (4) the relationship between cranial dimensions and intelligence. Contemporary physical anthropologists continue to study the first two topics. In the third area, emphasis has changed from “racial” to “ethnic” differences. Racial taxonomies by anthropometric criteria have proved futile. “It is difficult to define races and the usefulness of this concept, at least as applied to man, is doubtful” (Carmelli and Cavalli-Sfoma, 1979, p. 41). Genetic affinities between populations are better expressed in terms of blood group and plasma protein polymorphisms. Interest in the fourth area waned after Pearson (1906) showed the extremely low correlations between head size and intelligence, though occasional studies in this area continue to surface (Susanne, 1979). Perhaps a major change in recent decades has been the impressive growth in the application of physical anthropology to clinical problems. For purposes of this review, the following areas of clinical application have been selected: (1) growth and development; (2) nutrition and public health; (3) clinical medicine; (4) dysmorphology; and (5) physical fitness and sports. GROWTH AND DEVELOPMENT The late 1920s saw a rather sudden burst of interest in the causes of individual differences, both mental and physical. It was hoped that long-term studies of children 0096-848X/82/2501-0169$03.50cc) 1982 Alan R. Liss, Inc. 170 YEARBOOK OF PHYSICAL ANTHROPOLOGY [Vol. 25, 1982 would supply the elusive answers. Several “longitudinal” studies of the physical growth and psychological development of normal, white, middle class children were initiated almost simultaneously in the United States, followed somewhat later by similar programs abroad. In most of these studies, assessment of skeletal maturation was added to classical anthropometry, since it had long been known that development of ossification centers and closure of epiphyses are better indicators of physiological maturity than stature (Pryor, 1907; Rotch, 1909). Various methods of assessing skeletal maturity have been devised (Sontag et al., 1939; Greulich and Pyle, 1959; Garn et al., 1964; Tanner et al., 1975a; Roche et al., 1975). Validity, comparability and reproducibility of the various methods continue under investigation (Roche et al., 1971; Johnson et al., 1973). The subject is thoroughly covered in two recent reviews by Roche (1978, 1980a). The size of the full-term newborn is largely determined by the prenatal environment (Tanner et al., 1956; Olivier et al., 1978; Robson et al. 1981). It depends more on maternal than paternal size (Wingerd and Schoen, 19741, as was long ago demonstrated by the famous Shire horse-Shetland pony crosses of Walton and Hammond (1938). In the first year of life, length and weight often cross percentile channels (Smith et al., 1976) and by 3 years of age, the influence of prenatal environment has largely waned. Thereafter, the genotype of the child becomes dominant, and the effect of paternal stature equals that of maternal stature. From then until puberty, children’s percentile ranks remain remarkably constant; growth is “channeled.” Even extended periods of malnutrition or disease result in only temporary declines of growth rates. Once the cause of the growth failure is removed, accelerated or “catch-up” growth (Prader et al., 1963; Tanner, 1981)puts the child back into its pre-illness channel. Even catch-up growth of the brain seems possible, a t least in infancy (Marks et al., 1978; Roche, 1980b).After 10 to 12 years of age, catch-up growth is less predictable and often incomplete. Protein-calorie malnutrition (and probably other disorders) have a stronger inhibiting effect on stature than on skeletal maturation (Martorell et al., 1979). Catchup growth after renal transplantation has been extensively studied (Potter et al., 1970; Grushkin and Fine, 1973; Saenger et al., 1974; Hoda et al., 1975; Chesney et al., 1978). However, interpretation of available data is difficult since most patients required longterm corticosteroid therapy to prevent transplant rejection. Alternate-day steroid therapy seems to permit better catch-up growth. The channeling of growth allows prediction of adult stature from age, current stature, and skeletal maturity (Bayley and Pinneau, 1952). Prediction has been somewhat refined by accounting for midparental stature (Tanner et al., 1970, 1975b; Roche et al., 1975). Prediction methods have recently been reviewed by Roche (1980~). Interest in the accurate prediction of adult stature heightened when it was shown that the acceleration of puberty by estrogen therapy would limit the growth of excessively tall girls (Whitelaw et al., 1965; Roche and Wettenhall, 1969). Testosterone therapy has a comparable effect upon the stature of boys (Zachman et al., 1976). Fear of late side effects has made most United States physicians hesitant to use estrogen therapy for tall girls (Conference on Estrogen Treatment, 1978), though long-term studies of treated women by Wettenhall et al. (1975) fail to show disturbances of the menstrual cycle or impairment of fertility. The availability of stature prediction has been very helpful to the practicing pediatrician. The ability to predict, within relatively narrow limits, the onset of puberty and adult stature has reassured countless short children with constitutional delay of maturation (Gallagher, 1975) and has undoubtedly prevented a good deal of inappropriate endocrine therapy. It should be emphasized that methods for predicting adult stature should not be applied to children with skeletal dysplasias, other dwarfing syndromes, or chromosomal aberrations. Each of these disorders has its own growth and skeletal maturation pattern. Growth curves for several skeletal dysplasias have recently been published by Horton et al. (1978,19811,while those for children with the Russel-Silver syndrome have been reported by Tanner et al. (1975~).Patterns of growth and maturation in Down’s syndrome have been evaluated by Roche (1964, 1965); Rarick and Seefeldt (1974); Cronk Robinow] CLINICAL APPLICATIONS OF PHYSICAL ANTHROPOLOGY 171 (1978) and others, while Brook et al. (1974) have published growth curves for the XO (Turner) syndrome. The growth of the fetus has become an area of considerable clinical importance (see also the section “Clinical Medicine”). Fetal measurement and the growth of low-birthweight infants have recently been reviewed by Southgate (1978) and Brandt (1978). The standards of fetal length, weight, and head circumference by Lubchenco et al. (1963, 1966) are used in most hospital nurseries to decide whether infants are small for gestational age (intrauterine growth retardation), average, or large for gestational age (e.g., infants of diabetic mothers). Proper classification has an important bearing on management and prognosis. The Lubchenco data were derived from a racially mixed neonatal population in Denver, Colorado (altitude 1600 m). Subsequent reference data and growth charts (Usher and McLean, 1969; Babson et al., 1970; Babson and Benda, 1976)are more representative for the majority of United States and Canadian neonates. However, they have not been widely used in clinical pediatrics. Usher and McLean (1969) have also offered reference data for several additional fetal measurements. Norms for some other dimensions of premature and term neonates have had to be developed for various aspects of therapy, such as placement of gastric and duodenal feeding tubes and insertion of umbilical artery catheters (Dunn, 1966; Rosenfeld et al., 1980). The measurement of short-term neonatal growth in length has been facilitated by use of the Holtain neonatometer (Davies and Holding, 1972). NUTRITION AND PUBLIC HEALTH On a world-wide basis, malnutrition is the most prevalent health problem of children. Keppel(1968) estimated that 70% of all children under 6 years of age suffer from some degree of protein-calorie malnutrition. In the third world, malnutrition is also a common problem of childbearing women, especially the multiparous (Jelliffe, 1966). Malnourished women are also a t a substantially higher risk of producing low birthweight infants, and these low birthweights are due mainly to prematurity with its attending hazards (Falkner, 1981). Anthropometry is a rapid, inexpensive, noninvasive and sensitive method of assessing and monitoring the nutritional status of child populations (Jelliffe, 1966; Waterlow, 1972; Waterlow et al., 1977; Nichaman and Lane, 1979; Gebr6-Medhin, 1979), while chemical tests on blood or urine are more useful for detecting deficiencies of specific nutrients (iron, zinc, vitamins, etc.) than for assessing general health and overall nutritional status. Ideally, growth norms for children should be derived from a socioeconomically elite group of comparable genetic background (Garn, 1965; Walker and Richardson, 1973; Neuman, 1979). Such height and weight reference data have been developed for many populations, and comparisons have confirmed the existence of some racial differences in stature and body proportions (Greulich, 1957;Malina, 1969; Robson et al., 1975; Garn and Clark, 1976b; Eveleth and Tanner, 1976). Nevertheless, studies have also shown that the growth curves of well nourished infants and preschool children of different racial backgrounds are remarkably similar, so that reference growth data for United States children have not been as inappropriate for other populations as was once thought (Guzman, 1968; Habicht et al., 1974). Similarly, differences in mean menarcheal ages seem to reflect nutritional status more than genetic constitution (Frisch and Revelle, 1971; Tanner, 1973; Eveleth and Tanner, 1976). Nutrition also seems, to a large extent, to be responsible for “racial” differences in adult stature. This has been amply demonstrated by the secular increases of stature in populations that were once disadvantaged (Greulich, 1957; Meredith, 1976; Malina, 1979; Roche, 1979; Higman, 1979). The reverse has also been observed, i.e., socioeconomicallyadvantaged groups, such as Harvard and Wellesley college freshmen, have shown no significant increase of stature in recent decades (Bawkin and McLaughlin, 1964; Damon, 1974). Once populations have reached socioeconomicallyadvantaged status, true ‘%acial”(genetic) differences become apparent. Japanese in Japan and in California now seem to have attained their genetic potential for stature (Eveleth, 1979). In field studies of disadvantaged child populations, one needs simple anthropometric dimensions and indices to determine the prevalence of malnutrition and to select chil- 172 YEARBOOK OF PHYSICAL ANTHROPOLOGY (Vol. 25, 1982 dren who are in urgent need of intervention. Currently, the most popular indices of malnutrition are percentage of mean body weight for age and percentage of mean body weight for stature (Gomez et al., 1955; Jelliffe, 1966; Waterlow, 1972). A somewhat better understanding of nutritional status may be gained by adding estimates of body composition, especially of fat and muscle, which indicate calorie and protein reserves. In field studies, fat is generally estimated from skinfold measurements. Age- and sex-specific norms for triceps and subscapular skinfolds are available for several populations (Johnston et al., 1972,1974; Tanner and Whitehouse, 1975; Frisancho, 1981). Skinfold measurements may be combined with certain circumference measurements for estimates of relative body fatness (Behnke and Wilmore, 1974; Weltman and Katch, 1978). Correlations between skinfold measurements and the more precise laboratory estimates of fatness (e.g., underwater weighing, total body water) have been reasonably good (Forbes, 1964; Wilmore and Behnke, 1969; Frerichs et al., 1979; Boulton, 1981). A relatively recent addition to the field of nutritional anthropometry is the midarm circumference, a simple measure of muscle (i.e., protein) reserves (Jelliffe and Jelliffe, 1969; Shakir and Morley, 1974). Reference data have been published by Robinow and Jelliffe (1969), Burgess and Burgess (19691, and Frisancho (1981). The insertion tape (Zerfass, 1975) has contributed to measurement accuracy and reproducibility. Arm circumference for stature as read from the “QUAC stick” (Arnhold, 19691, has been recommended for the rapid detection of severe protein-calorie malnutrition, but Margo (1977) has questioned the value of this index. Correction of arm circumference for the thickness of the subcutaneous fat layer, as measured by the biceps and triceps skin folds, provides an estimate of mid-arm muscle mass (Jelliffe, 1966; Jelliffe and Jelliffe, 1969). Norms for this “arm muscle” circumference have been published by Frisancho (1981). Malnutrition occurs not only in the third world. It is a common problem in hospital patients of all ages and social strata, especially in those suffering from malabsorption, extensive burns, or advanced cancer. This long neglected area has received more attention since the introduction of “hyperalimentation,” i.e., complete intravenous nutrition (Dudrick et al., 1968). Unfortunately, anthropometry is not as finely tuned a tool for assessing the nutritional status of individuals or for monitoring short-term changes of hospital patients (Collins et al., 1979) as for monitoring child populations. Overnutrition, i.e. obesity is a problem primarily in the affluent world. While slim figures remain fashionable in the upper social strata, obesity in children and adults has become more prevalent in all the developed and in some underdeveloped countries (Neuman, 1979).The roles of heredity and environment in the genesis of obesity remain under investigation (Forbes, 1977; Garn and Clark, 1976a).The technique of measuring fat cell (adipocyte) size and number in the living (Hirsch and Gallian, 1968; Hirsch, 1975) and monitoring their changes with age promise to be a major advance in understanding the development and persistence of obesity (Knittle, 1972; Knittle et al., 1977).However, doubts about the validity of the technique and the conclusions based on the technique have been voiced by Widdowson and Shaw (19731,Ashwell and Garrow (1973), and others. Roche (1981) recently reviewed the adipocyte-number hypothesis and concluded that i t was untenable. Skeletal mineral is a n important component of the body. It accounts for about 10% of lean body weight (Behnke and Wilmore, 1974). Anthropometric methods for estimating bone mineral in the living are of relatively recent origin. Current methodologies are reviewed in a recent monograph edited by Cohn (1981). The contributing authors cover the basic principles and clinical applications of radiogrammetry, densitometry, photon absorptiometry, Compton scattering, computerized axial tomography, and neutron activation. Much has been learned of changes in skeletal mineral with age. Body mineral increases with growth through childhood. During puberty, sex hormones cause a striking endosteal and periosteal apposition of new bone in each sex. This gain is followed by a gradual loss, beginning a t 35 to 50 years of age (Garn, 1970; Trotter and Hixon, 1974). Bone loss is generally more rapid in females than in males. The bone loss of later years shows a great deal of individual variation, which is still poorly understood. Robinow] CLINICAL APPLICATIONS OF PHYSICAL ANTHROPOLOGY 173 The new methods are capable of detecting changes in cortical and cancellous bone long before they become visible in standard roentgenograms. In severe, generalized bone loss, the mineral content of a single metacarpal or phalanx is highly correlated with the mineral content of the entire skeleton, while in some other conditions bone loss is more regional and assessment of a single bone may not be representative (Meema and Meema, 1981). The newer methods of estimating skeletal mineral have been used to study skeletal changes and monitor therapy in hyperparathyroidism, renal disease, rickets, postmenopausal osteoporosis, osteogenesis irnperfecta, and so on. CLINICAL MEDICINE Diagnostic radiology is one of the corner stones of modern medicine. Diagnostic radiologists lean heavily on a great variety of skeletal and soft tissue dimensions, and new standards continue to be developed in response to clinical needs. For that reason, the work has been accomplished mainly by radiologists and clinicians rather than by physical anthropologists. Most of the reference data are scattered through the radiologic literature, but some have been collated in monographs (Lusted and Keats, 1967). Computerized axial tomography (CAT) provides a new means of viewing the interior of the body. Its introduction in 1972 has ushered in a new era for diagnostic medicine. Ultrasonography has made equally spectacular strides in the past decade. The regions once least accessible, i.e., the heart, brain and pregnant uterus, are now open to noninvasive visualization and measurement. Meanwhile, radiation exposure per study has been substantially reduced (CAT) or completely eliminated (ultrasonography). The diagnosis of acquired and congenital heart disease by ultrasonography has required the establishment of a great number of new norms for such dimensions as thickness of ventricular walls, size of cardiac chambers, diameter of valve rings, aortic and pulmonary artery roots, and so on (Feigenbaum, 1973; Epstein et al., 1975; Henry et al., 1975; Goldberg et al., 1980). Ultrasonography also permits better timing and more precise measurement of the functional capacity of the cardiac chambers. Until recently, the brain could be visualized only by invasive and potentially dangerous methods, such as pneumoencephalography or cerebral angiography. Now it can be seen in remarkable detail in CAT scans. In infants with open anterior fontanelles, ultrasonography yields similar structural detail. In the study of neonates, ultrasonography has great advantages since the equipment is portable and relatively inexpensive. The procedure does not require sedation or anesthesia as does CAT scanning. Ultrasound is thus particularly useful for repeated bedside studies. Interpretation of the new brain images has required new sets of norms for intracerebral dimensions (Haber et al., 1980; Sauerbrei et al., 1981, Babcock and Han, 1981). Comparisons of CAT %lices” with anatomical brain sections have been useful in identifying anatomic landmarks (Matsui and Hirano, 1979). Recent studies by Galaburda et al. (1978) and Geschwind (1979) have greatly advanced our knowledge of cortical localization of various intellectual skills and have demonstrated remarkable asymmetry of cortical organization. Functional localization is a developmental process (Trevarthen, 1979). Unilateral cortical insults in infancy permit a shift of some functions, e.g., speech, to the intact contralateral hemisphere. Although newer techniques (Editorial, Lancet, 1979; Brownell et al., 1982) permit visualization of regional cortical blood flow and metabolism during various motor, perceptual and mental activities, clinical applications have been delayed by technical problems, equipment cost, and, in the case of positron emission tomography (PET), the limited availability of the short-lived positron-emitting isotopes. Detailed study of the fetus and placenta is a completely new area, which has proved to be of great clinical importance. The improvement of ultrasonic equipment in the past five years (,,gray scale” and “real time” imaging) has greatly expanded its use in prenatal diagnosis and has opened a new field for applied anthropometry. Ultrasonic measurement of biparietal diameter (Campbell, 1968; Levi and Smets, 1971) and crown-rump length (Campbell and Dewhurst, 1971) permit estimation of fetal age within narrow limits, far more reliably than the time elapsed since the last menstrual period. Knowledge of fetal age is particularly important if amniocentesis is to be per- 174 YEARBOOK OF PHYSICAL ANTHROPOLOGY [Vol. 25, 1982 formed for the detection of genetic defects. The optimal time is 13 to 14 weeks after conception. Ultrasonography also provides information on the dimensions of the placenta, another field for normative study (Hellman et al., 19701, and the location of the placenta, which is important for the physician performing amniocentesis. Clinical applications of fetal studies are many. Intrauterine growth retardation can now be determined prenatally by estimating fetal weight from measurements of fetal abdominal circumference (Campbell and Wilkins, 1975)or intrauterine volume (Gohari et al., 1977). The ventricular system of the fetal brain is well visualized by ultrasonography (Headlock et al., 198l), and reference data for fetal ventricular dimensions have been established (Denkhaus and Winsberg, 1979). Hydrocephalus is easily diagnosed prenatally. Finally, fetal age, as estimated from fetal dimensions, is important for choosing the best time for the induction of labor or for caesarean section, if such intervention is necessary. Current knowledge of prenatal growth and development, as studied by ultrasound, is reviewed in a recent monograph (Hobbins, 1979). DYSMORPHOLOGY Dysmorphology and teratology are relatively new disciplines that have been expanding rapidly during the past two decades (Warkany, 1971; Smith, 1976; Gorlin et al., 1976). Various body dimensions and proportions, not commonly used in anthropometry or clinical medicine, have become important for the delineation of malformation syndromes and for therapeutic intervention, i.e., orthodontia, plastic, and craniofacial surgery. Age-specific reference data for several measurements, for example, ear length and width, intercanthal and interpupillary distances, palpebral fissure width, philtrum length, mouth width, and a number of facial proportions have been developed (Cervenka, 1969; Feingold and Bossert, 1974; Jones et al., 1978; Farkas, 1979; Miller et al., 1980; MBhes, 1981). However, more remains to be done in this vast, almost uncharted area of dysmorphology, and joint exploration by clinicians and physical anthropologists is indicated. New investigative techniques (e.g., Rabey, 1977) should help to provide age-, sex-, and race-specific norms for many facial features. Factor analysis should also prove useful in exploring the complex interrelationships. Age- and sex-specificnorms for length of the major limb bones, their ratios to stature (Maresh, 1970) and to each other (Robinow and Chumlea, 1982), and standards for metacarpal and phalangeal lengths (Garnet al., 1972)have proved useful in delineating disorders of disproportionate growth (skeletal dysplasias, etc.). EXERCISE, FITNESS, AND SPORTS Physical fitness is determined by a combination of physiologic and anthropometric parameters. In physiologic terms, fitness is “aerobic work capacity” or VOZ max, the maximum oxygen uptake per minute. Values vary with sex, age, stature, and weight (Astrand, 1960; Astrand and Rodahl, 1977). VOz max can be improved by training and, since it is related to body weight, by reduction of body fat (Davies et al., 1972). The reduced fitness of advancing years is, to some .extent, due to lack of exercise and to changes in body composition (loss of lean body mass, gain of fat). It is thus partly preventable and treatable (van HUSS,1979). Aerobic capacity, its measurement and determinants, and the concept of trainability during growth and adulthood have been comprehensively reviewed in the preceding volume of the Yearbook by Bouchard et al. (1981).Of clinical significance is the concept of “functional aerobic impairment,” the percentage difference between the measured VOz max and that predicted from age, sex, and activity status (Bruce et al., 1973). Physical anthropologists and human biologists have contributed significantly to several areas of sports medicine. Contributions range from the study of physique (e.g., Tanner, 1964; de Garay et al., 1974; Kunze et al., 1976), body composition (Novak et al., 1976; Wilmore and Bergfeld, 19791, and physiological function and performance of elite athletes (Shephard et al., 1974; Shephard, 1978; Houston and Green, 1976; Ward et al., 1979). Growth and maturity characteristics of young athletes and the effects of physical activity have been reviewed by Malina (1980, 1982). Robinow] CLINICAL APPLICATIONS OF PHYSICAL ANTHROPOLOGY 175 CONCLUSION The announcement of the demise of physical anthropology (Symposium “Physical Anthropolgy Is Dead,” 1975) is premature. Applied physical anthropology is thriving and its future looks bright. Physicians will probably continue to take the lead in developing norms that are medically relevant and statistically not too complex. Physical anthropologists will make their greatest contributions in solving problems involving multiple variables and requiring more sophisticated statistical treatment, and in projects involving large populations and elaborate study designs. ACKNOWLEDGMENTS Drs. R. M. Malina and A. F. Roche made many helpful suggestions which are gratefully acknowledged. LITERATURE CITED Arnhold, R (1969) The arm circumference a s a public health index of protein+alorie malnutrition of early childhood XVII.The Quac stick A field measure used by the Quaker Service Team in Nigeria. J. Trop. Pediat. 15243-247. Ashwell, M, and Garraw, JS (1973) Full and empty fat cells. Lancet 2:1036-1037. h t r a n d , I(1960) Aerobic work capacity in men and women with special reference to age. Acta Physiol. Scand., suppl. 49:4540. Astrand, P-0, and Rodahl, K (1977) Textbook of Work Physiology, 2nd edition. New York McGraw-Hill. Babcock, DS, and Han, BK (1981) The accuracy of high resolution, real-time ultrasonography of the head in infancy. Radiology 1393665-676. Babson, SG, Behrman, RE, and Lessel, R (1970) Fetal growth: live-born birth weights for gestational age of white middle class infanta. Pediatrics 453937-944. Babson, SG, and Benda, GI (1976) Growth graphs for the assessment of infants of varying gestational age. J Pediat. 89:814-820. Bakwin, H, and McLaughlin, SM (1964) Secular increase in height is the end in sight? Lancet 2:1195-1196. Bayley, N, and Pinneau, S (1952) Tables for predicting adult height from skeletal age, revised for use with Greulich-Pyle hand standards: J Pediat. 40:423-441. Behnke, AR, and Wilmore, J H (1974) Evaluation and Regulation of Body Build and Composition. Englewood Cliffs, New Jersey: Prentice-Hall. Bouchard, C, Thibault, MC, and Jabin, J (1981) Advances in selected areas afhuman work physiology. Yearbook Phys. Anthrop. 24:1-36. Brandt, I (1978) Growth dynamics of low-birth-weight infanta with emphasis on the perinatal period. In F Falkner and JM Tanner (eds): Human Growth, Volume 2. New York Plenum, pp. 557-617. Brook, CGD, Miirset, G, Zachman, M, and Prader, A (1974) Growth in children with 45 XO Turner’s syndrome. Arch. Dis. Child. 493789-795. Brownell, GL, Budinger, TF, Lauterbur, PC, and McGeer, PL (1982)Positron tomography and nuclear magnetic resonance imaging. Science 215:619-626. Bruce, RA, Kusumi, F, and Hosmer, D (1973) Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease. Am. Heart J. 85:546-562. Burgess, HJL, and Burgess, AP (1969) Modified standard for midarm circumference in young children. J. T n p . Pediat. 15:189-192. Campbell, S (1968) An improved method of fetal cephalometry by ultrasound. J. Obstet. Gynaec. Brit. Cwlth. 753568-596. Campbell, S, and Dewhurst, CJ (1971) Diagnosis of the small for date fetus by serial ultrasonic cephalometry. Lancet 2:1002-1006. Campbell, S, and Wilkins, D (1975) Ultrasonic measurement of fetal abdomen circumference in the estimation of fetal weight. Br. J. Obstet. Gynaecol. 82:689-697. Carmelli, D, and Cavalli-Sforza, LL (1979) The genetic origin of the Jews: A multivariate approach. Human Biol. 51:4141. Cervenka, J , Figalovh, P, and Gorlin, RJ (1969) Cranio-carpo-tarsal dysplasia or the whistling face syndrome 11. Oral intercommissural distance in children. Am. J. Dis. Child. 11 7:434-435. Chesney, RW, Moorthy, AV, Eisman, JA, Jax, DK, Mazess, RD, and DeLuca, H F (1978) Increased growth after long-term oral a,25-vitamin DI in childhood renal osteodystrophy. New Engl. J. Med. 298:238-242. Cohn, SH (14) (1981) Non-invasive Measurements of Bone Mass and Their Clinical Application. Cleveland CRC Press. Collins, P, McCarthy, ID, and Hill, GL (1979) Assessment of protein nutrition in surgical patients: the value of anthropometrics. Am. J. Clin. Nutr. 32:1527-1530. Conference on Estrogen Treatment for the Young (1978) Summary and recommendations. Pediatrics, suppl. 62:1216-1217. Cronk, CE (1978) Growth of children with Down’s syndrome: birth to age 3 years. Pediatrica 613564468. Damon, A (1974) Larger body size and earlier menarche: the end may be in sight. Soc. Biol. 2138-11. Davies, CTM, Barnes, C, and W r e y , S (1972) Body composition and maximal exercise performance in children. Human Biol. 44:195-214. 176 YEARBOOK OF PHYSICAL ANTHROPOLOGY [Vol. 25,1982 Davies, DP, and Holding, RE (1972)Neonatometer: a new infant length measurer. Arch. Dis. Child. 473938-940. deGaray, AL, Levine, L, and Carter, JEL (1974)Genetic and Anthropological Studies of Olympic Athletes. New York: Academic Press. Denkhaus H, and Winsberg, F (1979)Ultrasonic measurement of the fetal ventricular system. Radiology 131:781-787. Dudrick, SJ, Wilmore, DW, Vars, HM, and Rhoads, J E (1968)Long-term total parenteral nutrition with growth, development and positive nitrogen balance. Surgery 643134-142. Dunn, P (1966)Localization of the umbilical catheter by post-mortem measurement. Arch. Dis. Child. 41:69-75. Editorial (1979)Images of brain function. Lancet 2:725-726. Epstein, ML, Goldberg, SJ,Allen, HD, Konecke, L, and Wood, J (1975)Great vessel, cardiac chamber and wall growth patterns in normal children. Circulation 5131124-1129. Eveleth, PB (1979)Population differences in growth Environmental and genetic factors. In F Falkner and JM Tanner ( 4 s ) : Human Growth. Volume 2. New York Plenum, pp 373-394. Eveleth, PB, and Tanner, JM (1976)Worldwide Variation in Human Growth. Cambridge: Cambridge University Press. Falkner, F (1981)Maternal nutrition and fetal growth. Am. J. Clin. Nutr. 343769-774. Farkas, LG (1979)Anthropometry of normal and abnormal ears. Clin. Plast. Surg. 5:401-412. Feigenbaum, H (1973)Echocardiography. Philadelphia: Lea & Febiger. Feingold, M, and Bossert, WH (1974)Normal values for selected physical parameters. An aid in syndrome delineation . Birth Defects: Original Article Series, Vol. X,No. 13,pp. 1-15, National Foundation-March of Dimes. Forbes, GB (1964)Lean body mass and fat in obese children. Pediatrics 34:308323. Forbes, GB (1977)Nutrition and growth, J. Pediat. 91:40-42. Frerichs, RR, Harsha DW, and Berenson, GS (1979)Equations for estimating percentage of body fat in children 10-14 years old. Pediat. Res. 13:170-174. Frisancho, AR (1981)New norm8 of upper limb fat and muscle areas for assessment of nutritional status. Am. J . Clin. Nutr. 34.2540-2545. Frisch, RE, and Revelle, R (1971)The height and weight of girls and boys at the time of the initiation of the adolescent growth spurt and the relationship to menarche. Human Biol. 43:140-159. Galaburda, AM, Lemay M, Kemper, TL, and Geschwind, N (1978)Right-left asymmetries in the brain. Science 199:852-856. Gallagher, JR (1975)Short and tall stature in otherwise normal adolescents: management of their medical and psychologic problems. In LI Gardner (ed): Endocrine and Genetic Diseases of Childhood and Adolescence. Philadelphia: Saunders, pp. 99-105. Garn, SM (1965)The applicability of North American growth standards in developing countries. Can. Med. Ass. J . 933914-919, Garn, SM (1970)The Earlier Gain and Later Loss of Cortical Bone in Nutritional Perspective. Springfield, Illinois: Charles C. Thomas. Garn, SM, and Clark, DC (1976a)Trends in fatness and the origins of obesity. Pediatrics 573443456. Garn, SM, and Clark, DC (1976b)Problems in the assessment of Black individuals. Am. J. Phys. Anthropol. 66262-267. Garn, SM, Hertzog, KP, Poznanski, AK, and Nagy, JM (1972)Metacarpophalangeal length in the evaluation of skeletal malformation. Radiology 105:375-381. Garn, SM, Silverman, FN, and Rohman, CG (1964)A rational approach to the assessment of skeletal maturation. Ann. Radiol. 73297-307. GebrB-Medhin, M (1979)Nutrition surveillance in developing countries, with special reference to Ethiopia. In DB Jelliffe and EFP Jelliffe (eds): Human Nutrition, a Comprehensive Treatise. Volume 2. Nutrition and Growth. New York: Plenum, pp. 432-441. Geschwind, NC (1979)Specializations of the human brain. Sci. Am. 2413180-199 (Sept.). Gohari, P, Berkowitz, RL,and Hobbins,J C (1977)Prediction of intrauterine growth retardation by determination of total intrauterine volume. Am. J . Obstet. Gynec. 127.255-260. Goldberg, SJ, Allen, HD, and Sahn, DJ (1980)Pediatrics and Adolescent Echocardiography. A Handbook, 2nd ed. Chicago: Yearbook Publishers. Gomez, F, Galvan, RR, Cravioto, J, and Frenk, S (1955)Malnutrition in infancy and childhood with special reference to Kwashiorkor. Adv. Pediat. 7:131-169. Gorlin, RJ,Pindborg, JJ,and Cohen, MM (1976)Syndromes of the Head and Neck, 2nd ed. New York McGrawHill. Greulich, WW (1957)A comparison of the physical growth and development of American-born and native Japanese children. Am. J. Phys. Anthropol. 15:489-515. Greulich, WW, and Pyle, SI (1959)Radiographic Atlas of Skeletal Development of the Hand and Wrist, 2nd ed. Stanford, California: Stanford University Press. Grushkin, CM, and Fine, RN (1973)Growth in children following renal transplantation. Am. J . Dis. Child. 125.514-516. Guzman, MA (1968)Impaired physical growth and maturation in malnourished populations. In NS Scrimshaw and J E Gordon (eds):Malnutrition, Learning and Behavior. Cambridge, Massachusetts: MIT Press,pp. 42-54. Haber, KM, Wachter, RD, Christenson, PC, Vaucher, Y, Sahn, DJ, and Smith, JR (1980)Ultrasonic evaluation of intracranial pathology in infants: a new technique. Radiology 1343173-178. Habicht, JP, Martorell, R,Yarbrough, C, Malina, RM, and Klein, RE (1974)Height and weight standards for preschool children. How relevant are ethnic differences in growth potential? Lancet 1:611-615. Headlock, FP, Deter, RL, and Park, SK (1981)Real-time sonography: Ventricular and vascular anatomy of the fetal brain in utero. Am. J. Roentgenol. 136:133-137. Robinow] CLINICAL APPLICATIONS OF PHYSICAL ANTHROPOLOGY 177 Hellman, LM, Kobayashi, M, Tooles, WE, and Cromb, E (1970)Ultrasonic studies of the volumetric growth of the human placenta. Am. J . Obstet. Gynec. 108:740-750. Henry, WL, Ware, J , Gardin, JM, Hepner, SI, McKay, J , and Weiner, M (1975)Echocardiographic measurements in normal subjects. Growth related changes that occur between infancy and early adulthood. Circulation 57.278-284. Higman, BW (1979)Growth in Afro-Carribean slave populations. Am.J . Phys. Anthropol. 50:373-386. Hirsch, J (1975)Cell number and size as determinants of subsequent obesity. In M Winick (ed):Childhood Obesity. New York: Wiley, pp. 15-21. Hirsch, J , and Gallian, E (1968)Method for determination of adipose cell size in man and animals. J . Lipid Res. 9:llO-119. Hobbins, TL (ed.)(19791Diagnostic Ultrasound in Obstetrics. Diagnostic Clinics in Ultrasound. London: Churchill Livingstone. Hoda, 0, Hasinoff, DJ,and Arbus, GS (1975)Growth following renal transplantation in children and adolescents. Clin. Nephrol. 3:6-9. Horton, WA, Rotter, JI, Rimoin, DL, Scott, CI, and Hall, J G (1978)Standard growth curves for achondroplasia. J. Pediat. 93:435-438. Horton, WA, Hall, JG, Scott, CI, Pyeritz, RE, and Rimoin, DL (1982)Growth curves for height for diastrophic dysplasia, spondyloepiphyseal dysplasia congenita, pseudoachondroplasia. Am.J. Dis. Child. 136:316-319. Houston, ME, and Green, J H (1976)Physiological and anthropometric characteristics of elite Canadian ice hockey players. J. Sports Med. Phys. Fit. 16:123-128. Jelliffe, DB (1966)The Assessment of the Nutritional Status of the Community. Geneva: World Health Organization. Jelliffe, EFP, and Jelliffe, DB (eds) (1969)The arm circumference as a public health index of protein-calorie malnutrition of early childhood. J . Trop. Pediat. 15177-260. Johnson, GF, Dorst, JP, Kuhn, HP, Roche, AF, and Davila, GH (1973)Reliability of skeletal age assessments. Am.J . Roentgenol. 18:320927. Johnston, FE, Hamill, P W , and Lemeshow, S (1972)Skinfold thickness of children 6 1 1 years, United States. Vital and Health Statistics, Series 11,no. 120. Johnston, FE, Hamill, PVV, and Lemeshow, S (1974)Skinfold thickness of youths 12-17 years, United States. Vital and Health Statistics, Series 11,no. 132. Jones, KL, Hanson, JW, and Smith, DW (1978)Palpebral fissure size in newborn infants. J . Pediat. 92:787. Keppel, F (1968)Food for thought. In NS Scrimshaw and J E Gordon (eds): Malnutrition, Learning and Behavior. Cambridge, Massachusetts: MIT Press, pp. 4-9. Knittle, J L (1972)Obesity in Childhood a problem in adipose cellular development. J. Pediat. 81 :104%1059. Knittle, JL, Ginsberg-Fellner F, and Brown, RE (1977)Adipose tissue development in man. Am. J . Clin. Nutr. 30:762-766. Kunze, D, Hughes, PCR, and Tanner, JM (1976)Anthropometrische untersuchungen an sportlern der XX. Olympischen Spiele 1972 in Munchen. In H Jungmann (ed):Sportwissenschaftliche Untersuchungen wiihrend der XX OlympischenSpiele, Munchen 1972.Hamburg: Karl Demeter-Verlag, pp. 33-56. Levi, A, and Smets, P (1973)Intrauterine fetal growth studied by ultrasonic biparietal measurements. Acta Obstet. Gynec. Scand. 52:193-198. Lubchenco, LO, Hansman, C, Dressler, M, and Boyd, E (1963)Intrauterine growth as estimated from liveborn birth weight data at 24-42 weeks of gestation. Pediatrics 32:793-800. Lubchenco, LO, Hansman, C, and Boyd, E (1966)Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks.Pediatrics 37:403-408. Lusted, LB, and Keats, TE (1967)Roentgenographic Measurement, 2nd ed. Chicago: Yearbook Publishers. Malina, RM (1969)Growth and physical performance of American Negro and White children. Clin. Pediat. 8:476-483. Malina, RM (1979)Secular changes in size and maturity: causes and effects. Monogr. Soc. Res. Child Dev. 44:59-102. Malina, RM (1980)Physical activity, growth, and functional capacity. In FE Johnston, AF Roche and C Susanne (eds): Human Physical Growth and Maturation: Methodologies and Factors. New York Plenum, pp. 303-327. Malina, RM (1.982)Physical growth and maturity characteristics of young athletes. In RA Magill, MJ Ash and FL Smoll (eds): Children in Sport (2nd edition). Champaign, Illinois: Human Kinetics Publishers, in press. Maresh, MM (1970)Measurements from roentgenograms. In McCammon RW (ed): Human Growth and Development. Springfield, Illinois: Charles C. Thomas, pp. 187-200. Margo, C (1977)Assessing malnutrition with the mid-arm circumference. Am. J. Clin. Nutr. 30:835-837. Marks, HG, Borns, P,Steg, NL, Stine, SB, Stroud, HL, and Vates, TS (1978)Catch-up brain growth demonstration by CAT scan. J. Pediat. 93254-257. Martorell, R, Yarbrough, C, Klein, RE, and Lechtig, A (1979)Malnutrition, body size and skeletal maturation: interrelationships and implications for catch-up growth. Human Biol. 51 :371389. Matsui, T, and Hirano, A (1979)An Atlas of the Brain for Computerized Tomography. Tokyo: Igaku Shoin. Meema, HE, and Meema, S (1981)Radiogrammetry. In SH Cohn (ed):Non-invasive Measurements of Bone Mass and Their Clinical Applications. Cleveland CRC Press, pp. 5-50. MBhes, K (1981)Normal values for philtral length, oral intercommissural distance, and sternal length in newborn infants. J. Craniofacial Genet. 1:217-227. Meredith, HV (1976)Findings from Asia, Australia, Europe and North America on secular changes in mean height of children, youths and young adults. Am.J. Phys. Anthropol. 44:315325. Miller, R, Ross, WD, Rapp, A, and Roede, M (1980)Sex chromosome aneuploidy and anthropometry: a new proportionality assessment using the phantom stratagem. Am. J. Med. Genet. 5125-135. Neuman, CG (1979)Reference data. In DB Jelliffe and EFP Jelliffe (ede): Human Nutrition, A Comprehensive 178 YEARBOOK OF PHYSICAL ANTHROPOLOGY [Vol. 25, 1982 Treatise, Volume 2. Nutrition and Growth, New York Plenum, pp. 299-327. Nichaman, MZ, and Lane, JM (1979) Nutrition surveillance in developed countries. In DB Jelliffe and EFP Jelliffe (eds): Human Nutrition, a Comprehensive Treatise. Volume 2. Nutrition and Growth. New York Plenum, pp. 409-430. Novak, LP, Woodward, WA, Bestit, C, and Mellerowicz, H (1976) Working capacity (WC1701, body composition, and anthropometry of Olympic female athletes. In H Jungmann (ed): Sportwissenschaftliche Untersuchungen wahrend der XX Olympischen Spiele, Miinchen 1972. Hamburg: Karl Demeter-Verlag, pp. 69-78. Olivier, G, Bressac, F, and Tessier, H (1978) Correlations between birth length and adult stature. Human Biol. 50~69-72. Pearson, K (1906) On the relationship between intelligence and the size of the head, and to other physical and mental characteristics. Biometrika 5105-146. Potter, D, Belzer, FO, Rames, L, Holiday, MA, Kountz, SL, and Najarian, J S (1970) The treatment of chronic uremia in childhood. I. Transplantation. Pediatrics 45:432-%43. Prader, A, Tanner, JM, and von Harnack, GA (1963)Catch-up following illnesa or starvation. J. Pediat. 62:64E459. Pryor, JW (1907) The hereditary nature of variation in the ossification of bones. Anat. Rec. 1:84-88. Rabey, GP 11977) Morphanalysis of craniofacial dysharmony. Br. J. Oral Surg. 15:llO-120. b r i c k , GL, and Seefeldt, V (1974) Observations from longitudinal data on growth in stature and sitting height of children with Down's syndrome. J. Ment. Def. Res. 18:63-78. Robinow, M, and Chumlea, WC (1982)Standards for limb bone length ratios in children. Radiology I43:433-436. Robinow, M, and Jelliffe, DB (1969)The use of arm circumference in a field survey of early childhood malnutrition in Busoga, Uganda. J. Trop. Pediat. 15:217-221. Robson, EB (1981) Human birth weight: natural selection and genetics. In M Ritzen, A Aperia, K Hall, A Larsson, A Zetterberg, and R Zetterstrom (eds):The Biology of Normal Human Growth. New York Plenum, pp. 183-192. Robson, JRK, Larkin, FA, Bursick, JH, and Perri, KP (1975) Growth standards for infanta and children: a crosssectional study. Pediatrics 56:1014-1020. Roche, AF (1964) Skeletal maturation rates in mongolism. Am. J. Roentgenol. 91:979-987. Roche, AF (1965) The stature of mongols. J. Ment. Def. Res. 9.131-145. Roche, AF (1978) Bone growth and maturation. In F Falkner and JM Tanner (eds): Human Growth, Volume 2. New York Plenum, pp. 317-355. Roche, AF (1979) Secular trends in stature, weight and maturation. Monogr. Soc. Res. Child Dev. 44:3-27. Roche, AF (1980a) The measurement of skeletalmaturation. In FE Johnston, AF Roche, and C Susanne (eds): Human Growth and Maturation: Methodologies and Factors. New York: Plenum, pp. 61-82. Roche, AF (1980b) Possible catch-up growth of the brain in man. Acta Med. Auxol. 12:165-179. Roche, AF (1980~)Prediction. In FE Johnston, AF Roche and C Susanne (eds): Human Physical Growth and Maturation: Methodologies and Factors. New York Plenum, pp. 177-191. Roche, AF (1981) The adipocyte number hypothesis. Child Dev. 52:31-43. Roche, AF, Davila, GH, and Eyman, SL (1971) A comparison between Greulich-F'yle and Tanner-Whitehouse assessment of skeletal maturity. Radiology 98:273-280. Roche, AF, Wainer, H, and Thiessen, D (1975) The RWT method for the prediction of adult stature. Pediatrics 56:102&1033. Roche, AF, and Wettenhall, HNB (1969).The prediction of adult stature in tall girls. Austral. Paediat. 5:13-22. Rosenfeld, W, Biagtan, J, Schaeffer, H, Evans, H, Flicker, S, Salazar, D, and Jhaveri, R (1980) A new graph for umbilical artery catheters. J. Pediat. 919735-737. Rotch, TM (1909) A study of the development of the bones in childhood by the roentgen method, with the view of establishing a developmental index for the grading of and protection of early life. Trans. Am. Assn. Physicians 24:603630. Saenger, P, Wiedemann, E, Schwartz, E, Korth-Schultz, S, Lewy, J E , Riggio, RR, Rubin, AL, Stenzel, KH, and Newi, M (1974) Somatomedin and growth after renal transplantation. Pediat. Res. 8:163-169. Sauerbrei, EE, Digney, M, Harrison, PP, and Cooperberg, PL (1981) Ultrasonic evaluation of neonatal intracranial hemorrhage and its complications. Radiology 139:677-685. Shakir, A, and Morley, D (1974) Measuring malnutrition. Lancet I :758-759. Shephard, RJ (1978) The prediction of athletic performance by laboratory and field tests. In RJ Shephard and H Lavalee (eds): Physical Fitness. Springfield, Illinois: Charles C. Thomas, pp. 113-141. Shephard, FfJ, Godin, C, and Campbell, R 11974) Characteristics of sprint, medium and long distance swimmers. Eur. J. Appl. Physiol. 3299-116. Smith, DW (1976) Recognizable Patterns of Human Malformation, 2nd ed. Philadelphia: Saunders. Smith, DW, Truog, W, Rogers, J E , Greitzer, U,Skinner, AL, McCann, J J , and Harvey, MAS (1976) Shifting linear growth during infancy. Illustrations of genetic factors in growth during infancy. Illustrations of genetic factors in growth from fetal life through infancy. J. Pediat. 89225-230. Sontag, LW, Snell, D, and Anderson, M (1939) Rate of appearance of ossification centers from birth to 5 years. Am. J. Dis. Child. 38:949-956. Southgate, DAT (1978) Fetal measurements. In F Falkner and JM Tanner (eds): Human Growth, Volume 1. New York: Plenum, pp. 379-395. Susanne, C (1979) On the relationship between psychometric and anthropometric traita. Am. J. Phys. Anthropol. 51 r421-424. Symposium (1975) Physical anthropology is dead. Yearbook Phys. Anthropol. 19:132-152. Tanner, JM (1964) The Physique of the Olympic Athlete. London: George Allen and Unwin. Tanner, JM (1973)Trends toward earlier menarche in London, Oslo, Copenhagen, the Netherlands and Hungary. Nature 243:95-97. Robinow] CLINICAL APPLICATIONS O F PHYSICAL ANTHROPOLOGY 179 Tanner, JM (1981) Catch-up growth in man. Brit. Med. Bull. 37:233-238. Tanner, JM, Goldstein, H, and Whitehouse, R H (1970) Standards for children’s height at ages 2 to 9 years, allowing for weight of parents. Arch. Dis. Child. 45:755-762. Tanner, JM, Healy, MJR, Lockhart, RD, Mackenzie, JD, and Whitehouse, RH (1956) Aberdeen growth studv. The prediction of adult body measurements. Arch. Dis. Child. 31:372381. Tanner, JM, Lejarraga, H, and Cameron, N (1975) The natural history of the Silver-Russel syndrome: a longitudinal study of thirty-nine cases. Pediat. Res. 9:611-623. Tanner, JM, and Whitehouse, RH (1975) Revised standards for triceps and subscapular skinfolds in British children. Arch. Dis. Child. 50:142-145. Tanner, JM, Whitehouse, RH, Marshall, WA, and Carter, BS (1975b) Prediction of adult height fmm height, bone age and occurrence of menarche, ages 4-16 with allowance for midparent height. Arch. Dis. Child. 50:14-26. Tanner, JM, Whitehouse, RH, Marshall, WA, Healy, MJR, and Goldstein, H (1975a) Assessment of Skeletal Maturity and Prediction of Adult Height (TW2 method). New York Academic Press. Trevarthen, C (1979) Neuroembryology and the development of perception. In F Falkner and JM Tanner (eds): Human Growth. Volume 3. New York Plenum, pp. 3-96. Trotter, M, and Hixon, BB (1974) Sequential changes in weight, density and percentage ash weight of human skeletons from an early fetal period through old age. Anat. Rec. 179:1-18. Usher, R, and McLean, F (1969) Intrauterine growth of live-born Caucasian infants at sea level: standards obtained from measurements in 7 dimensions of infants born between 25 and 44 weeks of gestation. J. Pediat. 74:901-910. van Huss, D (1979) Physical activity and aging. In R Strauss (ed): Sports Medicine and Physiology. Philadelphia: Saunders, pp, 373-385. Walker, ARP,and Richardson, BD (1973)International and local p w t h standards.Am. J . Clin. Nutr. 26:897-900. Walton, A, and Hammond, J (1938)The maternal effects on growth and conformation in the Shire horseShetland pony crosses. Proc. Royal SOC.B. 125311-335. Ward, T, Groppel, JL, and Stone, M (1979) Anthropometry and performance in master and first class Olympic weight lifters. J. Sports Med. Phys. Fit. 19:205-212. Warkany, J (1971) Congenital Malformations. Chicago: Yearbook Medical Publishers. Wartenweiler, J , Hess, A, and Wuest, B (1974) Anthropologic measurements and performance. In LA Larson (ed):Fitness, Health and Work Capacity. New York: Macmillan, pp. 211-240. Waterlow, J C (1972) Classification and definition of protein-calorie malnutrition. Br. Med. J. 3:566-569. Waterlow, JC, Buzina, R, Keller, W, Lane, JM, Nichaman, MZ, and Tanner, JM (1977) The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years. Bull. World Health Org. 55:489-498. Weltman, A, and Katch, VL (1978) A new population-specific method for predicting total body volume and percent fat. Human Biol. 50:151-158. Wettenhall, HNB, Cahill. C, and Roche, AF (1975) Tall girls: a survey of 15 years of management and treatment. J. Pediat. 86:602-610. Whitelaw, MJ, Foster, TN, and Graham, WH (1965) Steroidal induction of premature growth spurt in prepubertal boys for excessive height. Acta Endocrinol. 50:317320. Widdowson, E, and Shaw, WT (1973) Full and empty fat cells. Lancet 2:905. Wilmore, JH, and Behnke, AR (1969) An anthropometric estimation of body density and lean body weight in young men. J. Appl. Physiol. 27:2531. Wilmore, JH, and Bergfeld, J A (1979) A comparison of sports: Physiological and medical aspects. In RH Strauss (ed): Sports Medicine and Physiology. Philadelphia: Saunders, pp. 353-372. Wingerd, J, and Schoen,EJ (1974)Factors influencing length at birth and height at 5 years. Pediatrics 53:737-741. Zachman, M, Fernandez, G, Murset, G, Gnehm, HE, and Prader, A (1976) Testosterone treatment of excessively tall boys. J . Pediat. 38:782-787. Zerfass, AJ (1975) The insertion tape: a new arm circumference tape for use in nutritional assessment. Am. J. Clin. Nutr. 28:782-787.