close

Вход

Забыли?

вход по аккаунту

?

Cross-cultural correlations of childhood growth and adult breast cancer.

код для вставкиСкачать
AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 73:525-537 (1987)
Cross-Cultural Correlations of Childhood Growth and
Adult Breast Cancer
MARC S. MICOZZI
Cancer Prevention Studies Branch, Blair 6A01, National Cancer Institute,
9000 Rockuille Pike, Bethesda, MD 208924200
KEY WORDS
Anthropometry, Nutrition, Diet, Growth
ABSTRACT
International differences in breast cancer incidence and mortality, and studies on Japanese migrants to the United States, point to the
importance of environmental factors, including diet and nutrition, in the etiology of breast cancer. Some studies have suggested that dietary patterns in
early life are important to the long-term risk of breast cancer. Given that
human growth is partially a function of early dietary intake, cross-cultural
correlations between breast cancer rates and anthropometric variables measured at different times in childhood provide additional information about the
association of early nutrition and cancer. In this study, the associations between food consumption and anthropometric variables, and childhood growth
patterns (attained size at age) and adult breast cancer rates, were considered.
Data from cross-sectional growth studies conducted during the years 19561971 on children aged 6-18 years were obtained for age-specificstature, sitting
height, weight, triceps skinfold thickness, arm and chest circumferences, and
biacromial and biiliac diameters. National food consumption data were obtained from the United Nations Food and Agriculture Organization (FA01 and
socioeconomic status indicators from the United Nations Children’s Fund
(UNICEF). Cancer incidence data for the years 1972-1977 were obtained from
regional cancer registries reported by the International Agency for Research
on Cancer (IARC), and mortality data for 1978 were obtained from national
cancer registries around the world.
Significant correlations were seen between national food consumption data
and childhood growth (attained size at age); between cancer incidence and agespecific stature (r = 0.68), weight (r = 0.59), triceps skinfold thickness (r =
0.78), and biacromial width (r = 0.84); and between mortality and age-specific
stature (r = 0.77), weight (r = 0.75), and biacromial width (r = 0.78). In
general, the correlation coefficients of the observed anthropometric variables
with breast cancer increase with increasing age and become highly significant
at ages 13-14 years, reflecting cumulative childhood nutritional intake.
Breast cancer has historically been the
most frequent cancer in women (115,000 new
cases per year), and is the leading cause of
cancer death in women (36,000 deaths per
year) in the United States. International differences in breast cancer incidence and mortality rates (Tables 1, 2), and studies on
migrating Japanese-American populations,
point to the potential importance of environmental factors in the etiology of breast cancer in women. The Japanese-American mi-
0 1987 ALAN R. LISS, INC
grant studies further suggest that dietary
acculturation early in life is a critical variable for long-term breast cancer risk (Buell
and Dunn, 1965; Buell, 1973; Dunn, 1977).
Human epidemiologic studies show high correlations between national levels of breast
cancer and per capita consumption of several
Received May 7,1986; revision accepted October 20, 1986
M.S. MICOZZI
526
TABLE I . Cross-national comparison of breast cancer incidence rates
Country
Years of study
Senegal
Singapore (Malay)
Japan
Poland (rural)
India
Singapore (Chinese)
Hungary (rural)
Puerto Rico
Romania
Czechoslovakia
Hong Kong (Chines6?)
Colombia
Yugoslavia
Spain
Poland (urban)
Jamaica
Finland
Norway
Australia
Denmark
France
Sweden
West Germany
Brazil
U.S. (Asian)
Italy
Britain
Israel
New Zealand
Canada
U.S. (black)
Switzerland
U.S. (white)
1969
1973-1977
1973-1977
1973-1977
1973-1975
1973-1977
1973-1977
1963
1974-1978
1973-1977
1974-1977
?972-?976
1973-1976
1973-1977
1973-1977
1973-1977
1971-1976
1973-1977
1973-1977
1968-1972
1975-1977
1973-1977
1973-1977
1973
1972-1977
1976-1977
1973-1977
1972-1976
1972-1976
1973-1977
1973-1977
1964
1973-1977
Breast cancer incidence
per 100,000 population
(age-standardizedrates)'
11.8
14.7
17.5
17.7
21.2
21.9
29.2
29.5
30.1
30.3
31.1
33.2
34.2
36.5
36.5
39.0
40.1
49.6
53.2
54.4
54.5
55.2
55.7
56.2
57.3
57.6
58.4
59.9
62.6
63.2
67.2
76.1
83.7
'Incidence data from Waterhouse e t al. (1982)
macronutrients, including dietary fat, protein, and total calories (Armstrong and Doll,
1975; Gaskill et al., 1979; Gray et al., 1979).
These ecologic studies make use of national
food consumption, or food disappearance,
data that are only indirect indicators of nutrition and do not distinguish patterns by
age, sex, or other demographic characteristics within the population. Case-control studies of diet and breast cancer have obtained
dietary data on individuals but have generally focused attention on current nutritional
patterns in breast cancer cases (Phillips,
1975; Miller et al., 1978; Lubin et al., 1981).
However, few or no data are available on the
relationships of a single assessment of nutritional status at one point in time to longterm nutritional status or to the multistage
process of tumor development (Micozzi, 1985).
The role of nutrient intake in the development of cancer appears to depend on the timing, duration, and magnitude of dietary
exposures. One interpretation (Miller, 1977)
of the overall pattern of epidemiologic evidence on diet and breast cancer is consistent
with the view that dietary intake in early
life is a critical variable.
Based on analysis of age-incidence curves
for breast cancer in different populations
around the world, the likely conclusion is
that the risk factors that have caused increased breast cancer rates in some populations in recent years are basically determined
before the age of appreciable incidence is
reached (Bjarnason et al., 1974). Either exposure to relevant risk factors is confined to
younger women or, if the exposure is widely
spread in the population (as with diet), then
only the young are susceptible.
A mechanism for the effects of early nutritional patterns on the long-term risk of breast
cancer is suggested by the two-stage model
of carcinogenesis proposed by Moolgavkar et
al. (1980). Nutrients, like hormones, may influence the risk of breast cancer by their
effects on the growth of normal, conneoplastic tissue. The promotional effects of macronutrients on breast cancer development have
been demonstrated in a n animal tumor model
(Ross et al., 1983). Early breast secretory ac-
527
CHILDHOOD GROWTH AND ADULT BREAST CANCER
tivity may also be stimulated by diet (Petrakis et al., 1981), and aspects of breast
biology may be influenced by nutrient intake
in early life (DeSouza et al., 1974;Berg, 1975).
If nutrient intake in early life is an important determinant of the long-term risk of
breast cancer, then case-control studies on
elderly cancer patients may not be the most
appropriate way to test hypotheses about the
relationship between diet and breast cancer.
Given the limitations of indirect dietary assessment (Block, 19821, measurement of nutrition-mediated variables that reflect growth
(and can be determined in adults) may be
meaningful for the assessment of past nutritional patterns. Anthropometry provides a
reliable means of assessing past, as well as
current, nutritional patterns (Johnston, 1981,
1983).
Increased intake of macronutrients during
the growth period is associated with increased stature and lean body mass and accelerated rates of maturation. The former are
reflected in increased height and body size in
adults, the latter by early age at menarche
in women. Overnutrition in childhood may
also be related to increased childhood and
adult fatness. Fatter children are taller,
heavier, and developmentally advanced compared to the lean (Garn et al., 1982; Roche,
1984; Himes and Roche, 1985). These tendencies begin early in life, and excessive
macronutrient consumption during the postnatal period may lead to increased muscle
growth, fat deposition, or, probably, both
(Hahn and Koldovsky, 1966; Haymond et al.,
1974). Thus increased macronutrient intake
during growth and development may eventually lead to an adult whose size is close to
the maximum for that genotype (Stini, 1978).
Cross-sectional growth data from different
populations are based on physical measurements taken in children that are related to
nutrition in childhood. As an alternate means
of nutritional assessment, childhood growth
(attained size at age) can be used to test hypotheses about the relations of early nutrition to the long-term risk of breast cancer.
Based on these observations, a hypothesis
was developed that attained size at age during childhood, which partially reflects nutritional exposures, is directly related to the
risk of breast cancer in adult life among different populations (Micozzi, 1985). To perform an initial test of the hypothesis in an
ecologic model, a data base was constructed
consisting of reliable, age-specific growth
data.
TABLE 2. Cross-national comparison of breast cancer
mortality rates (1978-1979)
Breast cancer deaths
per 100,000population
(age-standardized rates)'
Country
Japan
Hong Kong
Singapore
Yugoslavia
Romania
Spain
Poland
Bulgaria
Greece
U.S. (black)
Finland
Israel
Australia
Italy
Canada
New Zealand
France
Hungary
Norway
Austria
Sweden
Netherlands
West Germany
Switzerland
Denmark
Belgium
Great Britain
U S . (white)
6.5
9 .o
10.2
15.2
15.6
17.8
18.0
18.9
20.1
21.2
22.6
24.0
24.0
28.1
28.1
29.1
30.3
32.3
32.5
33.7
34.5
37.2
37.3
39.5
41.3
42.0
47.6
52.1
'Mortality data from Kurihara et a1 (1984)
MATERIALS AND METHODS
Growth data were obtained from cross-sectional studies that collected anthropometric
dimensions on children aged 6-18 years (Eveleth and Tanner, 1976). Not all studies included data on all ages in this range (Table
3). Growth data were obtained only on populations for whom breast cancer incidence and/
or mortality data were also available. The
criteria of Waterlow et al. (1977)were considered for selection of each growth study included in the analysis: The population
studied was not clinically malnourished; the
samples were cross-sectional; and sampling
procedures were defined and reproduceable;
at least 200 individuals were included at each
age interval, and age groups were presented
in 1-year intervals; and measurements were
carefully made and recorded by observers
trained in anthropometric techniques, using
equipment of well-tested design and calibrated at frequent intervals. The year of performance of all studies selected was sometime
during the period 1956-1971 to minimize the
effects of secular trend on relative ranking of
population growth patterns. Size at age 18
years is taken as adult size (Meredith, 1971).
528
M.S. MICOZZI
TABLE 3. Human growth studies in data base
Population
Sample (size)'
Location
Argentina (white)
Urban (c. 100)
La Plata
Australia (white)
Austria (white)
Belgium (white)
Brazil (white)
Bulgaria (white)
Urban (c. 1,500)
Urban (c. 3,000)
Urban (500)
Urban (c. 500)
Urban (c. 400)
Sydney
Vienna
Brussels
Sao Paolo
Sofia
Canada (white)
Urban (c. 100)
Montreal
Costa Rica (white)
Urban (c. 250)
National
Cuba (white)
Urban (c. 60)
Havana
Czechoslovakia
(white)
Denmark (white)
Finland (white)
Urban (c. 3,000)
Prague
Urban (c. 40)
Urban (740)
Copenhagen
Helsinki
France (white)'
Germany, West
(white)
Great Britain
(white)
Greece (white)
Urban (165)
Urban (c. 1,000)
Paris
Hamburg
Urban (c. 1,000)
London
Urban (c. 250)
National
Guatemala (white)
Urban (c. 45)
Hong Kong (Chinese)
Hungary (white)
India (Asian)
Israel (white)
Urban (c. 500)
Urban (c. 200)
National (c. 10,000)
National (c. 20)
Guatemala
City
Nation a 1
Zged
National
Jews
Italy (white)
Italy (white)
Japan (Asian)
Urban (c. 250)
Rural (c. 500)
National (all)
Naples
Sardinia
National
Jamaica (black)
Malaysia (Asian)
Urban (c. 25)
Rural (c. 40)
Kingston
Muar
Netherlands (white)
National (c. 1,000)
National
New Zealand (white)
National (c. 800)
National
Norway (white)
Poland (white)
Poland (white)
Urban (c. 6,000)
Urban (c. 300)
Rural (c. 160)
Oslo
Warsaw
Warsaw
Philippines (Asian)
National (c. 400)
National
Puerto Rico (white)
Rumania (white)
Senegal (black)
Singapore (Malay)
Singapore (Chinese)
Spain (white)
Urban (c. 100)
Urban (c. 100)
Urban (c. 300)
Urban (c. 200)
Urban (c. 200)
Urban (100)
San Juan
National
Dakar
National
National
Madrid
Sweden (white)'
Switzerland (white)
U.S. (white)'
U S . (black)'
U.S. (Asian)
U.S.S.R. (white)
Yueoslavia
(white)
"
Urban (c. 360)
Urban (c. 130)
Urban (c. 300)
Urban (c. 150)
Urban (c. 30)
Urban (c. 200)
Rural (c. 100)
National
Basle
Philadelphia
Philadelphia
Los Angeles
Moscow
Lika
'At each year of age.
'Longitudinal study.
Authors
Years of
study
Ages
(years)
1971
6-12
1970
1962
1960-1961
1968-1969
1963
6-18
6-10
6-18
6-12
6-18
1969-1970
6-16
1963-1969
6-18
1963-1964
7-18
1971
6-18
Andersen, 1968
BackstromJarvinen, 1964
Sempe et al., 1971
city of Hamburg,
1962
Tanner et al., 1966
1968
1959-1960
8-18
6-18
1960-1971
1960
6-17
6-18
1965
6-18
Valaoras and Laros,
1969
Sabharwal et al.,
1966
Chang, 1969
Farkas, 1966
Indian Council, 1972
Shiloh and Yekutiel,
1958
Tatafiore, 1970
Pinna, 1961
Tokyo Dept. Health,
1970
Ashcroft et al., 1966
Wadsworth and Lee,
1960
Wieringen et al.,
1971
New Zealand Dept.
Health, 1971
Iversen, 1962
Charzewska, 1973
Panek and Piasecki.
1971
Natl. Coord. Center,
1965
Knott, 1963
Cristescu, 1969
Masse, 1969
Wong et al., 1972
Wong et al., 1972
Garcia-Almansa et
al., 1969
Ljung et al., 1974
Heimendinger, 1964
Krognian, 1970
Krogman, 1970
Kondo and Eto. 1975
Vlastovskv et al.. nd
Gavrilovi:, 1971
1963-1966
6-12
1961-1965
7-17
1961-1965
1958-1959
1956-1965
1956
6-18
6-17
6-18
6-11
1963
1961
1963-1970
6-18
6-12
6-17
1964
1960
6-18
6-12
1964-1966
6-18
1969
6-15
Cusminsky and
Lozano, 1974
Jones et al., 1973
Stracker, 1964
Twiesselmann, 1969
Marcondes et al., nd
Kadanof and
Mutafov, 1969
Demirjian et al.,
1972
Villarejos et al.,
1971
LaskaMierzejewska, 1967
Prokopec et al., 1973
1959-1960
1971
1960
7-18
10-18
6-18
1963-1964
6-17
1962
1963-1966
1960-1962
1972
1972
1968
7-17
11-16
6-15
6-14
6-14
6-14
1964-1971
1956-1957
1956- 1966
1956-1966
1971
1969-1970
1971
10-16
6-18
7-17
7-17
6-17
6-1 7
7-15
CHILDHOOD GROWTH AND ADULT BREAST CANCER
Growth data are multidimensional, and
anthropometric dimensions selected for analysis represent indices of linear growth, frame
size, and lean body mass as well as absolute
and relative body fatness. Anthropometric
variables recorded from each study included
age-specific stature, weight, sitting height,
triceps skinfold thickness, arm and chest circumferences, and biiliac (pelvic width) and
biacromial (shoulder width) diameters. For
this analysis, all reported measurements
were rounded to three significant figures in
appropriate units. All studies recorded height
and weight; not all studies recorded all the
remaining variables. The set of populations
for whom complete anthropometric data were
available was biased to include proportionately more European countries, which were
more tightly clustered on one part of the
curve. In this respect, the ability to demonstrate any relations with breast cancer would
be as strong as or stronger than results demonstrated with the complete data set across
the full range of variation.
National food consumption data were collected from the Food and Agriculture Organization (FAO), Rome, National Food
Disappearance Tables. Annual per capita
food consumption data on total amounts of
foods and nutrients, and calories from foods,
were obtained for each country for both the
earliest available period (1961-1965 annual
average) and for the latest (1977).These data
were taken as representative of overall adult
food consumption patterns, since no samples
are distinguished by age or sex. Food consumption data could also not be differentiated for urban vs. rural populations.
Indicators of socioeconomic status (SES)
were obtained from the United Nations Children’s Fund (UNICEF, 1984, 1985) for all
countries from which populations were included in this analysis. SES indicators were
obtained from both 1960 and 1981 when possible. Infant mortality rates (per 1,000 live
births), gross national product, average life
expectancies in men and women, total fertility rates (total children per woman), and percentage share of household income held by
the lower 40% and the upper 20% of SES
class.
Data on average age of menarche in different populations were obtained as tabulated
by Eveleth and Tanner (1976) and included
studies conducted during the period 19591973. Thus the menarche data were collected
on approximately the same cohort of women
529
for whom growth data were obtained, over a
sufficiently narrow time period, t o minimize
the effects of secular trend.
Age-standardized breast cancer incidence
rates (Waterhouse et al., 1982)for 32 populations and mortality rates (Kurihara et al.,
1984) for 35 countries were obtained for
which acceptable growth data were also
available (Tables 1-3). Age-specific breast
cancer incidence rates allow probable comparison of premenopausal and postmenopausal breast cancer.
Anthropometric data and breast cancer incidence data were both identified as to
whether data originated from urban or rural
populations. Thus, in the correlations between these two variables, populations are
independently identified and examined by
urban or rural status. In some countries, data
were available on both urban and rural populations, and the two sets of paired observations were examined independently in the
correlation analysis. When both anthropometric and cancer data were available for
subpopulations within a country, these populations were treated separately. For example, U.S. whites, U.S. blacks, and U.S. Asians
have separate growth data and cancer data,
as do Polish urban and Polish rural populations (Tables 1-3). For many other countries,
anthropometric data are available on rural
populations, but not cancer incidence data;
these populations could not be included in
this analysis. For breast cancer mortality and
food consumption, only national data are
available by country. Therefore, the same
national food consumption and breast cancer
mortality data were matched to each representative population. Since not all populations had anthropometric data available at
all ages between 6 and 18 years, analyses
were also performed, in each case limited to
the set of populations for whom anthropometric data were available at all ages over the
range. Since national breast cancer mortality data were available for a subset of 20
countries from 1964, and 35 countries from
1978, analyses were also performed only on
the subset of countries having data available
for both 1964 and 1978 to allow observation
of any time trends.
RESULTS AND DISCUSSION
Anthropometric variables in children
showing significant correlations to both
breast cancer incidence and mortality rates
were height, weight, and biacromial width
530
M.S. MICOZZI
TABLE 4. Correlation of breast cancer rates with age-specific mean stature in 32 populations'
Age
(years)
6
7
8
9
10
11
12
13
14
15
16
17
18
N2
Premenopausal
(BCI40)
Incidence
Postmenopausal
(BCI70)
Total
(BCIALL)
Mortality
N
BCMALL
25
30
30
30
32
32
32
31
31
28
25
22
14
0.61
0.51
0.53
0.57
0.53
0.54
0.52
0.58
0.80
0.61
0.63
0.65
0.67
0.58
0.48
0.47
0.52
0.48
0.48
0.47
0.55
0.58
0.60
0.65
0.70
0.72
0.54
0.41
0.46
0.49
0.49
0.48
0.47
0.53
0.54
0.56
0.56
0.57
0.68
23
29
29
29
31
30
30
28
28
26
24
21
15
0.49
0.38
0.56
0.56
0.53
0.45
0.56
0.65
0.62
0.75
0.77
0.74
0.72
Ip < 0.01 for all values reported.
'N, no. of paired observations.
TABLE 5. Correlation of breast cancer rates with age-specific mean weight in 32 populations'
Age
(vears)
N
Premenopausal
(BCI40)
6
7
8
9
10
11
12
13
14
15
16
17
18
25
30
30
30
32
32
32
31
31
28
25
22
15
0.62
0.59
0.59
0.52
0.48
0.51
0.49
0.57
0.65
0.59
0.45
0.50
0.57
Incidence
Postmenopausal
(BCI70)
0.51
0.48
0.50
0.43
0.39
0.42
0.38
0.46
0.55
0.57
0.45
0.50
0.61
Mortality
Total
(BCIALL)
0.56
0.49
0.53
0.45
0.45
0.47
0.44
0.53
0.59
0.54
0.37
0.44
0.59
N
BCMALL
22
28
28
28
30
29
29
27
27
25
23
20
15
-_
0.48
0.39
0.46
0.42
0.37
0.37
0.42
0.43
0.50
0.58
0.69
0.68
0.75
'p < .01for all values reported.
(Tables 4-6). Triceps skinfold thickness and
upper arm circumference were significantly
associated with breast cancer incidence but
not with mortality (Tables 7,8). In Tables 48, age-specific breast cancer incidence rates
a t ages 40 (BCI40) and 70 (BC170) years are
provided as representative of premenopausal
and postmenopausal women, respectively, in
addition to overall age-adjusted rates
(BCIALL). Since most growth studies did not
record all anthropometric measurements,
sample size was small and correlations were
not significant over most ages for chest circumference, sitting height, and biiliac (pelvic) width.
Among measures of frame size, biacromial
width (Table 6), but not biiliac width, was
significantly correlated to breast cancer
rates. In addition, mean sitting height
showed significant associations to overall
age-adjusted breast cancer incidence rates,
but not mortality rates, at ages 7-10 years
only (r = 0.47-0.62). The correlation coefficient of breast cancer rates with height,
weight, triceps skinfold thickness, and biacromial diameter increase with increasing
age (Tables 4-6). The correlation coefficients
did not change appreciably when breast cancer mortality data from 1964 were used as
compared to the mortality data from the
same set of populations from 1978. As is
shown in the tables, anthropometric dimensions were not available a t every age in different populations. The trend for increasing
correlation coefficients between anthropometric dimensions and breast cancer rates
did not diminish when analysis was limited
to populations for whom data were available
at all ages between 6 and 18 years.
In Table 7, it can be seen that childhood
fatness is as highly correlated to premenopausal as to postmenopausal cancer rates.
531
CHILDHOOD GROWTH AND ADULT BREAST CANCER
TABLE 6. Correlation o f breast cancer rates with age-specific mean
biacromial width (shoulder) in 17 populations
Age
bears)
6
7
8
9
10
11
12
13
14
15
16
17
18
N
Premenopausal
(BCI40)
14
16
14
14
15
15
16
15
15
12
10
8
7
NS1
0.69
0.71
0.71
0.71
0.66
0.66
0.74
0.77
0.76
NS
0.63
0.75
Incidence
Postmenopausal
(BCI70)
NS
0.72
0.72
0.73
0.74
0.70
0.72
0.80
0.78
0.84
NS
NS
NS
Mortality
Total
(BCIALL)
NS
0.70
0.71
0.71
0.73
0.68
0.68
0.78
0.77
0.81
NS
NS
NS
N
BCMALL
12
17
13
15
16
16
17
16
16
14
12
10
8
NS
NS
0.44
0.40
0.45
NS
NS
NS
0.41
0.47
0.67
0.78
0.71
INS, Not significant. Otherwise, p < ,005
TABLE 7. Correlation of breast cancer rates with agespecific mean triceps
skinfold thickness in 16 populations
Age
(years)
6
7
8
9
10
11
12
13
14
15
16
17
18
N
16
16
16
15
16
16
16
15
14
11
10
8
5
Premenopausal
(BCI40)
Incidence
Postmenopausal
(BCI70)
0.55
0.57
0.67
0.61
0.59
0.66
0.53
0.65
0.72
0.70
0.75
0.58
0.83
0.46
0.45
0.54
0.50
0.48
0.59
0.49
0.58
0.63
0.66
0.58
0.38
0.78
Mortality
Total
(BCIALL)
N
BCMALL
0.56
0.53
0.67
0.60
0.60
0.66
0.55
0.68
0.75
0.74
0.77
0.64
0.78
12
14
14
13
14
14
14
12
11
9
9
7
4
0.52
NS1
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
INS, Not significant (p > 0.10). Otherwise, p < 0.03
The correlations with age-specificbiacromial
width (an index of frame size) and with upper
arm circumference (reflecting both body fatness and lean body mass) in Tables 6 and 8,
respectively, are significant over a greater
range of ages with premenopausal (age 40
years) than with postmenopausal (age 70
years) breast cancer incidence rates.
Different anthropometric dimensions reflect linear growth, frame size, lean body
mass, and/or body fatness. Both indices of
absolute size (stature, sitting height, frame
size, lean body mass) and fatness (triceps
skinfold thickness) are correlated with increased breast cancer risk. Given that growth
is partially a function of early dietary intake,
these cross-national correlations between
cancer rates and anthropometric dimensions
at different points during childhood (attained
size at age) provide additional information
about the relationship of increased macronutrient intake to breast cancer risk in human populations. The correlations between
breast cancer and each of the anthropometric
dimensions is highest for the oldest age group
and increases with each year of age. Dietary
differences between populations are cumulatively reflected in the growth curve by
greater size differences at older, rather than
younger, ages. The trend that correlations
increase with older age lends further support
t o the associations between diet and cancer.
The strength of the correlations between
breast cancer and height and weight increases with increasing age (Table 9). These
correlation coefficients markedly increase
beginning after age 13 years. Age 13years is
also the time in life when Japanese-American migrants (Froelich, 1970; Kondo and Eto,
1975) begin to show growth rates signifi-
532
M.S. MICOZZI
TABLE 8. Correlation of breast cancer rates with age-specific mean arm circumference in 12 populations
Age
(years)
N
6
7
8
9
10
11
12
13
14
15
16
17
9
9
8
8
9
9
10
10
10
8
7
6
18
5
Premenopausal
(BCI40)
Incidence
Postmenopausal
(BCI70)
NS'
Mortalitv
Total
(BCIALL)
NS
NS
0.66
0.80
0.71
0.58
0.58
0.56
0.52
0.66
0.59
0.41
.
0.55
0.72
0.62
0.50
0.49
0.52
0.46
0.61
NS
NS
NS
NS
~~
0.70
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
NS
N
BCMALL
9
0.67
11
NS
NS
~~
10
NS
10
11
11
12
11
11
10
9
8
6
NS
NS
NS
NS
NS
NS
NS
NS
0.79
INS, Not significant (p > 0.10).Otherwise, p < 0.05.
TABLE 9. Cross-national correlation of age-specific anthropometric measures with
age-adiwted breast cancer mortalitv
Age (years)
6
7
8
9
10
11
12
13
14
15
16
17
18
Stature
(N)1
Correlation between breast cancer mortality and
Weight
(N)
Biacromial width (N)
0.49 (23)
0.38 (29)
0.56 (29)
0.56 (29)
0.53 (31)
0.45 (30)
0.56 (30)
0.65 (28)
0.62 (28)
0.75 (26)
0.77 (24)
0.74 (21)
0.72 (15)
0.48 (22)
0.39 (28)
0.46 (28)
0.42 (28)
0.37 (30)
0.37 (29)
0.42 (29)
0.43 (27)
0.50 (27)
0.58 (25)
0.69 (23)
0.68 (20)
0.75 (15)
NS2 (12)
NS (17)
0.44 (15)
0.40 (15)
0.45 (16)
NS (16)
NS (17)
NS (16)
0.41 (16)
0.47 (14)
0.67 (12)
0.78 (10)
0.71 (8)
'N, No. of paired observations.
'NS, Not significant. Otherwise, p < 0.05
cantly increased over those of their Japanese
counterparts living in Japan (Tokyo Department of Maternal and Child Health, 1970)
and over earlier generations of JapaneseAmerican migrants to California (Greulich,
1957). The correlation coefficients between
breast cancer and biacromial diameter also
became significant after age 13 years and
increase with increasing age (Table 9).
When the growth patterns of Japanese girls
in Japan (Tokyo Dept. Health, 1970) and earlier generations of Japanese-American girls
in California (Greulich, 1957) are compared
with those of later generations of JapaneseAmerican girls in California (Froelich, 1970;
Kondo and Eto, 19751, it is also seen that
there is some decrease in the gap between
their growth patterns at older ages (see Eveleth and Tanner, 1976, Fig. 102, p. 135). This
observation may be explained by the later
average age of menarche among populations
of Japanese girls with less early growth,
which allows some continued growth at later
ages.
The relationships of cancer with age at
menarche were consistent with previous reports but were not as strongly or as significantly correlated (Table 10) as were
relationships with anthropometric variables.
Some correlations with various socioeconomic indicators were not significant. For
those that were significant, the correlation
coefficients generally were not greater than
those for anthropometric variables. Fertility
rates were inversely correlated with breast
cancer rates, corresponding to the established protective effect of early age at first
pregnancy, and the known association between early age at birth of the first child and
high parity. The correlation coefficients be-
533
CHILDHOOD GROWTH AND ADULT BREAST CANCER
TABLE 10. Correlation of breast cancer rates with various socioeconomic indicators in 32 populations
N
BCI40
BCI70
BCIALL
N
BCMALL
Infant mortality (per 1,000 live births)
31
1960
31
1981
GNP U.S. dollars
31
1981
-0.54
-0.49
0.71
-0.45
-0.40
0.67
-0.50
-0.45
0.73
32
32
32
-0.65
-0.49
0.56
31
31
0.56
0.51
0.47
0.43
0.52
0.46
32
32
0.67
0.34
31
31
0.55
0.50
0.47
0.42
0.51
0.46
32
32
0.66
0.37
Average life expectancy (years)
Males
1960
1981
Females
1960
1981
Average age of
menarche
(years) 1959-1973
Total fertility
(children per
woman)
1960
1981
Percentage share
of household income
% Income of lower 40%
6 . S . dollars)
% Income of higher 20%
29
-0.41
-0.37
-0.39
26
NS
30
30
-0.43
- 0.46
-0.35
-0.40
-0.38
-0.44
32
32
-0.54
-0.61
18
NS'
NS
NS
20
0.57
18
NS
NS
NS
20
-0.67
INS, Not significant. Otherwise, p < 0.05
tween cancer rates and average life expectancy were smaller than those between
cancer rates and anthropometric or nutritional variables. Although cancer is more
common in aged populations, the overall ageadjusted cancer rates show that longevity
does not explain the geographic pattern of
breast cancer.
The growth and cancer relationships hold
up independently when socioeconomic status
is taken into account i n multivariate analyses (not shown). The growth and nutrition
relationships also explain observations in
different populations among whom cancer
patterns cannot be explained by socioeconomic factors. For example, in New Zealand,
Maori women have greater childhood growth,
greater adult body size, lower SES (New Zealand Department of Health, 1971)and higher
breast cancer rates (Henderson, 1979) than
white women.
Several studies on Samoans in American
Samoa (Borrie, 1967; Hoadley, 1980; Dines et
al., 1980; Taylor and Zimmet, 1981; Wood
and Gans, 1981, 1984) are generally consistent with the observations that Samoan
women may have greater childhood growth
and adult body size, although socioeconomic
indicators are lower. The body size and body
composition of Samoan children have been
related to infant feeding patterns; further,
the relations between infant feeding and
childhood fatness were not affected by family
income (Bindon, 1984a). In studies of 330 Samoan adults living in American Samoa and
Hawaii (Bindon, 198413) and 2,657 Samoan
adults in American Samoa, Western Samoa,
and Hawaii (Bindon and Baker, 1985), obesity and relative micronutrient deficiency
were related to modernity of residence or occupation. Other data (Government of American Samoa, 1975; Crews, 1985)are consistent
with high rates of breast cancer in American
Samoan women. Thus American Samoan
women appear to represent another example
of a population who have increased childhood
nutrition and growth, greater adult body size,
lower SES, and high age-specific breast cancer rates as compared to other populations.
Hawaiian women are also generally larger
and have lower SES but higher breast cancer
rates than whites over most age groups
(Horm et al., 1984). The same situation may
apply among Kanak women in French New
Caledonia (Garenne, 1985).
This ecologic model indicates that childhood height, weight, and biacromial width
are highly correlated with breast cancer rates
534
M.S. MICOZZI
in adult women among different populations.
In the one case-control study on anthropometry and breast cancer (Brinkley et al.,
1971), height, sitting height, weight, biacromial width, and biacromial-biiliac ratio
were greater among breast cancer cases than
among controls. The current study did not
permit complete characterization of sitting
height or biiliac width with respect to adult
breast cancer rates. However, there is a n indication that increased sitting height was
significant over some ages and that biiliac
diameter was less significant than biacromial diameter. Both these observations may
have implications for nutritional patterns
and the timing of age at menarch vis-a-vis
upper body (shoulder width and sitting
height) vs. lower body (pelvic width and leg
length) development.
These ecologic analyses are consistent with
a role for childhood nutrition in determining
adult breast cancer rates in different populations. The correlations between food disappearance data and attained size at age, and
between food disappearance data and adult
breast cancer rates, were also significant.
However, these results are not presented in
support of the hypothesis because of the indirect, unvalidated nature of food disappearance data and the inability to distinguish
patterns of consumption by sex or age, although they nonetheless demonstrate
“tracking” of nutritional patterns through
life cross-culturally. A more productive and
relevant approach to further testing of the
hypothesis, recognizing the above limitations, is to construct multivariate models for
the prediction of breast cancer that incorporate various measures of childhood nutrition
(attained size at age) with measures of adult
nutrition (taken as food disappearance data).
Preliminary findings with these models show
a highly significant contribution of childhood
nutrition to explanatory models using a wide
range of relevant adult nutritional variables
(Micozzi, 1986). Adult nutrition (food disappearance data) does not account for the crosscultural variability in breast cancer rates,
which can be explained by measures of early
nutrition in the same populations.
Although there is general tracking of comparative nutritional patterns among different human populations, the multivariate
analyses showed that the variability in
breast cancer rates among different populations cannot be explained primarily by adult
food consumption but that indicators of childhood nutrition (anthropometric variables)
have independent significance in the models.
Measures of childhood fatness, frame size,
and height were significantly correlated to
both premenopausal and postmenopausal
breast cancer rates in adult women in the
correlation analysis. Adult fatness is independent of height and frame size and is a
recognized risk factor only among older, postmenopausal women (when a distinction is
made; see Micozzi, 1985). Childhood fatness
is correlated with increased height, frame
size, and lean body mass, all of which are
indicators of increased nutrition during
childhood and all of which appear to be risk
factors for adult breast cancer a s well.
These ecologic models remain consistent
with a role for childhood nutrition, as reflected by age-specific anthropometric variables, in determining adult breast cancer
rates. The hypothesis of early nutrition and
breast cancer can be further tested using anthropometric data in individual adults (which
reflect early nutritional patterns). Individual
anthropometric data were prospectively obtained on adult women, for whom subsequent breast cancer outcome was determined,
in the US. National Health and Nutrition
Examination Survey (NHANES) epidemiologic follow-up Study.
Of all the variables studied among this
population, breast cancer cases had significantly greater mean height and frame size
(elbow width) than noncases (Micozzi, 1986).
Adult height and frame size are generally
determined by age 18years and are not influenced by adult nutrition. In this analysis,
indicators of adult nutritional patterns
(weight, body mass indices, body fatness)
were not associated with breast cancer. These
findings are consistent with a role for increased nutrition during childhood in determining the long-term risk of breast cancer in
human populations. Thus, beyond the ecologic models presented, these results are consistent with the hypothesis using data collected on individuals.
These observations lend further support to
a n association between increased macronutrient intake during childhood and the subsequent risk of breast cancer in adulthood.
LITERATURE CITED
Andersen, E (1968) Skeletal maturation of Danish
schoolchildren in relation to height. Sexual development and social conditions. Aarhus: Universitatsforlaget.
Armstrong, B and Doll, R (1975) Environmental factors
and cancer incidence and mortality in different coun-
CHILDHOOD GROWTH AN13 ADULT BREAST CANCER
535
tries, with special reference to dietary practices. Int. J. Farkas, GY (1966) Die Anderung der wichtigsten KorCancer 15~617-631.
permasse der Kinder von Szeged (Sudungarn) Zwischen
dem 3 und 18 lebensjahre. Acta Biol. (Szeged) 12:l-2.
Ashcroft, MT, Heneage, P, and Lovell, HA (1966)Heights
and weights of Jamaican schoolchildren of various eth- Froelich, J W (1970)Migration and plasticity of physique
nic groups. Am. J. Phys. Anthropol. 24:35-44.
in the Japanese-Americans of Hawaii. Am. J. Phys.
Backstrom-Jarvinen, L (1964) Heights and weights of
Anthropol. 22:429-442.
Finnish children and young adults. Ann. Paediatr. Garcia-Almansa, A, Fernandez, MD, and Palacios MaSupplement 23,116 pp.
teos, J M (1969) Patrones de crecimiento de 10s ninos
espanoles normales. Rev. Clin. Espanola 113:45-48.
Berg, JW (1975) Can nutrition explain the pattern of
international epidemiology of hormone-dependent can- Garenne, M (1985)Office de la Recherche Scientifique et
cers? Cancer Res. 35:3345-3350.
Technique Outre-Mer (ORSTOM), Republic of France,
Personal communication.
Bindon, JR (1984a) The body build and body composition
of Samoan children: Relationships to infant feeding Garn, SM, Ryan, AS, and Higgins, MW (1982) Implicapatterns and infant weight-for-length status. Am. J.
tions of fatness and leanness. Am. J. Phys. Anthropol.
Phys. Anthropol. 63:379-388.
57:191.
Bindon, JR (1984b) An evaluation of the diet of three Gaskill, SP, McGuire, WL, Osborne, CK, and Stern, MP
groups of Samoan adults: Modernization and dietary
(1979) Breast cancer mortality and diet in the United
adequacy. Ecol. Food Nutr. f4:105-115.
States. Cancer Res. 39:3628-3637.
Bindon, JR and Baker, PT (1985) Modernization, migra- Gavrilovic, A (1971) The anthropometrical research of
tion and obesity among Samoan adults. Ann. Hum
the first and second generation of the descendants of
Biology 12:67-76.
people from Lika settled in Vojvodina. Srpsko Biolosko
Drustvo, Novi Sad, 80 pp. (in Yugoslav with English
Bjarnason, 0, Day N, Snaedel, G, and Tulinius, H (1974)
summary).
The effect of year of birth on the breast cancer ageincidence curve in Iceland. Int. J. Cancer 13:689-696.
Government of American Samoa (1975) Health Care
Chart Book. American Samoa: Department of Medical
Block, G (1982)A review of validations of dietary assessServices.
ment methods. Am. J. Epidemiol. f15:492-505.
Borrie, WD (1967) Malthusian reflections on the South Gray, GE, Pike, MC, and Henderson, BE (1979) Breast
cancer incidence and mortality rates in different counPacific. Trans. R. Soc. New Zealand 2r19-29.
tries in relation to known risk factors and dietary
Brinkley, D, Carpenter, RG, and Haybittle, JL (1971) An
practices. Br. J. Cancer 39:l-7.
anthropometric study of women with cancer. Br. J.
Prev. SOC.
Med. 25:65-75.
Greulich, WW (1957) A comparison of the physical
growth and development of American-born and native
Buell, P (1973) Changing incidence of breast cancer in
Japanese children. Am. J. Phys. Anthropol. 15r489Japanese-American women. J. Natl. Cancer Inst.
515.
5fr1479-1483.
Buell, P and Dunn, J (1965) Cancer mortality of Japa- Hahn, 0 and Koldovsky, 0 (1966) Utilization of Nutrients During Postnatal Development. London: Pernese Isei and Nisei of California. Cancer 18:656-664.
gamon Press.
Chang, KSF (1969) Growth and Development of Chinese
Children and Youth in Hong Kong. Hong Kong: Uni- Hamburg, City of (1962) Die Schulkinder-Messung und
Wagung in Mai/Juni Freie und Hansestadt Hamburg
versity of Hong Kong.
Gesundheitsbehorde, Medizinalstatistik (mimeograph).
Charzewska, J (1973) Normal values of body height and
weight in Warsaw children. Roczniki Panstwowego Haymond, MW, Karl, IE, and Pagliari, AS (1974) Increased gluconeogenic substrates in the small-for-gesZakladu Higieny 24:617-625 (in Polish with English
tational-age infant. N. Engl. J. Med. 291:322.
summary).
Crews, DE (1985)Mortality, Survivorship and Longevity Heimendinger, J (1964) Die Ergebnisse von Korpermessungen a n 5000 Basler Kindern von 2-18 Jahren. Helv.
in American Samoa 1950 to 1981. PhD dissertation,
Paediatr. Acta Vol. 19, Suppl. 13.
Department of Anthropology.
Critescu, M (1969) Aspecte ale cresterii si dezvoltarii Henderson, BE (1979) Discussion of the hormonal basis
of breast cancer. Second Symposium on Epidemiology
adolescentilor din Republica Socialista Romania. Buand Cancer Registries in the Pacific Basin. Natl. Cancharest: Editura Academiei Republicii Socialiste
cer Inst. Monogr. 53:192-193.
Romania.
Cusminsky, M and Lozano, GA (1974) Investigacion del Himes, JH and Roche, AF (1985) Subcutaneous fat and
stature: relationships from infancy to adulthood. Ann.
crecimiento y desarrollo del nino de 4 and 12 anos.
Hum. Biol. l2[Suppl. 1]:55.
Ministerio de Bienestar Social, La Plata. Pennsylvania
Hoadley, JS (1980) Aid, politics and hospitals in western
State University, State College, PA.
Samoa. World Dev. 8:443-455.
Demirjian, A, Jenicek, M, and Dubuc, MB (1972) Les
normes staturo-ponderales de I’enfant urbain canadien Horm, JW,Asire, AJ, Young, JL, and Pollack, ES (1984)
SEER Program: Cancer Incidence and Mortality in the
francais d’age scolaire. Can. J. Public Health 63:14United States 1973-1981. NIH Publ. No. 85-1837,
30.
USPHS, Bethesda, MD: National Cancer Institute.
DeSouza, I, Morgan, L, Lewis, UJ, Raggatt, PR, Salih,
H, and Hobbs, JR (1974) Growth hormone dependence Indian Council of Medical Research (1972) Growth and
among human breast cancers. Lancet 2:182-184.
physical development of Indian infants and children.
Technical Report Series No. 18, New Delhi: ICMR.
Dines, DR, Anderson, NE, and Gorman, DF (1980) The
nutritional status of children in western Samoa. J. Iversen, I (1962) Beretningfra avdelingfor skollelegevesTrop. Pediatr. 26:95-99.
enfor skolearet 1959-60. In Beretning fra Oslo helserad for aret 1960. Oslo: J Chr Gunderson, pp. 128Dunn, JE (1977) Breast Cancer among American Japa134.
nese in the San Francisco Bay area. In Epidemiology
and Cancer Registries in the Pacific Basin-I. Natl. Johnston, FE (1981) Physical growth and development
and nutritional status: Epidemiological consideraCancer. Inst. Monogr. 47:157-160.
tions. Fed. Proc. 40:2583-2587.
Eveleth, PB and Tanner, JM (1976) Worldwide Variations in Growth. Cambridge: Cambridge University Johnston, FE (1983) The uses of anthropometry. Acta
Med. Auxol. 15:69-74.
Press.
536
M.S. M ICOZZI
Jones, DL, Hemphill, W, and Meyers, ESA (1973) Height,
weight and other physical characteristics of New South
Wales children. Part I. Children aged five years and
over. New South Wales: Department of Health G,
96543-aK5705.
Kadanof, D and Mutafov, S (1969) Uber das Wachstumpstempo und die korperliche Entwicklung von
Kindern und Jugendlichen von 3 bis 18 Jahren. Z.
Morphol. Anthropol. 61.258-271.
‘ondo, S and Eto, M (1975) Physical growth studies on
Japanese-American children in comparison with native Japanese. In: Proceedings of Meeting for Review
and Seminar of the U.S.-Japan Cooperative Research
es, (JIBP Synthesis, Vol. 1).
Tokyo: University of Tokyo Press, pp. 13-45.
Knott, VB (1963) Stature, leg girth, and body weight of
Puerto Rican private school children measured in 1962.
Growth 27: 157-174.
Krogman, WM (1970) Growth of the head, face, trunk,
and limbs in Philadelphia white and Negro children of
elementary and high school age. Monogr. SOC.Res.
Child Dev. 35:l-80.
Kurihara, M, Aoki, K, and Tominaga, S (1984) Cancer
Mortality Statistics in the World. Nagoya, Japan: University of Nagoya Press.
Laska-Mierzejewska, T (19671 Desarrolla y maduracion
de 10s ninos y jovenes Habaneros. Materialy i Prace
Antropologiczne 74:9-64.
Ljung, B, Brucefors, A, and Lindgren, G (1974) The secular trend in physical growth in Sweden. Ann. Hum.
Biol. 1:245-256.
Lubin, JH, Burns, PE, Blot, WJ, Ziegler, RG, Lees, AV,
and Fraumeni, JF (1981) Dietary factors and breast
cancer risk. Int. J. Cancer 28.685689.
Marcondes, E, Berquo, ES, Yunes, J, Luongo, J, Martins,
JS, Zacchi, MAS, Levy, MSF, and Hegg, R (nd) Estudo
antropometrico de criancas brasileiras de zero a doze
anos de idade. Anais Nestle 84:l-200.
Masse, G (1969)Croissance et developpement de l’enfant
a Dakar. Biometr. Hum. 4.13-23.
Meredith, HV (1971) Worldwide somatic comparisons
among contemporary human groups of adult females.
Am. J. Phys. Anthropol. 34.89-132.
Micozzi, MS (1985) Nutrition, body size and breast cancer. Yearbook Phys. Anthropol. 28:175-206.
Micozzi, MS (1986) Childhood Nutrition, Growth and
Development: Relation to the Long-Term Risk of Breast
Cancer in Human Populations. PhD dissertation in
Biomedical Anthropology, University of Pennsylvania,
Philadelphia. Ann Arbor: University Microfilms Int
Miller, AB (1977) Role of nutrition in the etiology of
breast cancer. Cancer 39:2704-2708.
Miller, AB, Kelly, A, Choi, NW, Matthews, V, Morgan,
RW, Munan, L, Burch, JD, Feather, J, Howe, GR, and
Jain, M (1978) A study of diet and breast cancer. Am.
J. Epidemiol. 107:499-509.
Moolgavkar, SH, Day, NE, and Stevens, RG (1980)Twostage model for carcinogenesis: Epidemiology of breast
cancer in females. J. Natl. Cancer. Inst. 65559-569.
National Coordinating Center (1965) The study and development of Filipino children and youth. Bulletin No.
1,Series 1965, Quezon City, Philippines: NCC.
New Zealand Department of Health (1971) Physical development of New Zealand schoolchildren, 1969. Special Report No. 38, Health Services Research Unit,
Wellington: Department of Health.
Panek, S and Piasecki, E (1971)Nowa Huta: Integration
of the population in the light of anthropological data.
Materialy i Prace Antropologiczne 80.1-249.
Petrakis, NL, Ernster, VL, Sacks, ST, King, EB,
Schweitzer, TKJ, Hunt, TK, and King, MC (1981)Epidemiology of breast fluid secretion: Association with
breast cancer risk factors and cerumen type. J. Natl.
Cancer Inst. 67:277.
Pinna, P (1961) Rilievi anthropometrici nei bambini di
Sassari fra un mese e dodici anni. Ann. Ital. Pediatr.
24~30-53.
Phillips, RL (1975) Role of life-style and dietary habits
in risk of cancer among Seventh-Day Adventists. Cancer Res. 35:3515-3522.
Prokopec, M, Suchy, J, and Titbachova, S (1973)Results
of the third whole-state investigation of the youth in
1971 (Czech countries). Cesk. Pediatr. 28:341-346 (in
Czech with English summary).
Roche, AF (1984)Anthropometric methods: New and old.
What they tell us. Int. J. Obesity 8.509-523.
Ross, MH, Bras, G, and Lustbader, ED (1983)Diet, body
weight and tumor susceptibility. 28th Scientific Report, Philadelphia: Institute for Cancer Research, Fox
Chase Cancer Center, pp. 18-20.
Sabharwal, KP, Morales, S, annd Mendez, J (19661 Body
measurements and creatinine excretion among upper
and lower socio-economicgroups of girls in Guatemala.
Hum. Biol. 38:131-140.
Sempe, P, Sempe, M, and Pedron, G (1971)Croissance et
Maturation Osseuse. Paris: Theraplix.
Shiloh, A, and Yekutiel, M (1958) Weights and heights
of Israeli children. Acta Med. Oriental. 17.17-23.
Stini, WA (1978) Early nutrition, growth, disease and
human longevity. Nutr. Cancer 1.3-39.
Stracker, OA (1964)Die gegenwartigen Korpermasse der
Kinder und Jugendlichen. Wiener Med. Wochenschr.
244r816-818.
Tanner, JM, Whitehouse, RH, and Takaishi, M (1966)
Standards from birth t o maturity for height, weight,
height velocity and weight velocity: British children
1965. Arch. Dis. Child. 41:454-471,613-635.
Tatafiore, E (1970) Aggiornamento dei dati medi napoletani di Deso e statura. Infanzia 20t17-32.
Taylor, RH and Zimmet, PZ (1981) Obesity and diabetes
in western Samoa. Int. J. Obesity 5:367-376.
Tokyo Department of Maternal and Child Health (1970)
Physical Status of Japanese Children in 1970. Tokyo:
Institute of Public Health.
Twiesselmann, F (1969) Development Biometrique de
1’Enfant a 1’Adulte. Brussels: Presses Universitaires
de Bruxelles.
United Nation’s Children’s Fund (UNICEF) (1984)World
Statistics on Children. First edition, New York:
UNICEF.
United Nation’s Children’s Fund (UNICEF) (1985) The
State of the World’s Children. London: Oxford University Press.
Valaoras, V and Laros, K (1969) Biometric characteristics of Greek pupils in elementary schools. IATRIKI
15266-276 (in Greek with English summary).
Villarejos, VM, Osborne, JA, Payne, FJ, and Arguedes,
JA (1971) Heights and weights of children in urban
and rural Costa Rica. Environ. Child Health 27:31-43.
Vlastovsky, VG, Grachera, GS, Minkina, VA, and Schevchenko, LG (nd) Unpublished data on Moscow children
1969-1970.
Wadsworth, GR and Lee, TS (1960) The height, weight,
and skinfold thickness of Muar schoolchildren. J. Trop.
Pediatr. 6.48-54.
Waterhouse, J, Muir, C, Shanmugaratnam, K, and Powell, J (1982) Cancer Incidence in Five Continents, Vol.
N.Lyons: IARC Scientific Publ. No. 42.
CHILDHOOD GROWTH AND ADULT BREAST CANCER
Waterlow, JC, Buzina, R, Keller, W, Lane, JM, Nichaman, M Z , 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. WHO 55,489-498.
Wieringen, JC van, Wafelbakker, F, Verbrugge, HP, and
de Haas, JH (1971) Growth Diagrams 1965, Netherlands. Groningen: Walters-Noordhoff Publishing.
Wong Hock Boon, Tye Cho Yoke, and Quek Kai Miew
537
(1972) Anthropometric studies on Singapore children.
I. Heights, weights and skull circumference on preschool children. J. Singapore Paediatr. Soc. 14,6849.
Wood, CS and Gans, LP (1981) Hematological status of
reproductive women in Samoa: An analysis of biometric data. Hum. Biol. 53:268-279.
Wood, CS and Gans, LP (1984)Aspects of child health in
western Samoa: A medical anthropological view. J.
Trop. Pediatr. 30:104-110.
Документ
Категория
Без категории
Просмотров
0
Размер файла
1 060 Кб
Теги
adults, correlation, cancer, growth, cultural, childhood, cross, breast
1/--страниц
Пожаловаться на содержимое документа