Childhood malnutrition and growth in a rural area of Western Kenya

An anthropometric survey was carried out on 1,383 school students aged 5-17 years in Suba district (a rural area of western Kenya). Body size and proportion were computed from height, weight, sitting height, arm circumference, and skinfolds. The aim of the study was to evaluate patterns of growth and nutritional status of the Luo population by assessment of the prevalence and trends of malnutrition among children and adolescents. Very few age-groups show significant sex differences for height, body weight, and arm muscle area. However, there are several differences in skinfold thicknesses and arm circumference, always with higher mean values in girls. Analysis of the nutritional status (weight-for-age, height-for-age, and BMI-for-age) shows significant differences among the age-groups in both sexes. Boys present lower Z-scores than girls and there are higher percentages of malnourished subjects (stunted and underweight) among the males. The Luo data were compared with those of other African populations. Their body dimensions, nutritional status, and growth are similar to those of the other sub-Saharan samples. In conclusion, the Luo children are generally undernourished at the older ages: adolescents (11-16 years of age) show the most severe undernutrition and the highest percentages of undernourished subjects. In addition to the higher risk of undernutrition in teenagers, an emerging problem of over-nutrition is evident among the younger age-groups, with a higher prevalence in females. These findings are discussed in light of sexual dimorphism in sensitivity to adverse environmental conditions.     

Trisomic pregnancy and earlier age at menopause

We tested the hypothesis that the connection between advanced maternal age and autosomal trisomy reflects the diminution of the oocyte pool with age. Because menopause occurs when the number of oocytes falls below some threshold, our hypothesis is that menopause occurs at an earlier age among women with trisomic pregnancies than it does among women with chromosomally normal pregnancies. To determine their menstrual status, we interviewed women from our previous study of karyotyped spontaneous abortions who, in 1993, were age >/=44 years. Premenopausal women completed interviews every 4-5 mo, until menopause or until the study ended in 1997. The primary analyses compare 111 women whose index pregnancy was a trisomic spontaneous abortion with two groups: women whose index pregnancy was a chromosomally normal loss (n=157) and women whose index pregnancy was a chromosomally normal birth (n=226). We used a parametric logistic survival analysis to compare median ages at menopause. The estimated median age at menopause was 0.96 years earlier (95% confidence interval -0.18 to 2.10) among women with trisomic losses than it was among women with chromosomally normal losses and chromosomally normal births combined. Results were unaltered by adjustment for education, ethnicity, and cigarette smoking. Our results support the hypothesis that trisomy risk is increased with decreased numbers of oocytes. Decreased numbers may indicate accelerated oocyte atresia or fewer oocytes formed during fetal development.     

Socioeconomic transition and physical growth of Tupí-Mondê Amerindian children of the Aripuan? Park, Brazilian Amazon

Anthropometric assessment of nutritional status is reported for three Tupí-Mondê-speaking groups from Rond?nia and Mato Grosso, Brazil. This region of the Amazon basin is experiencing rapid development through government-oriented colonization. The Gavi?o, Suruí, and Zoró had their first contacts with Brazilian national society at different times, and the nature and degree of their participation in regional markets varies. Height, weight, sitting height, subischial leg length, upper arm circumference, triceps skin-fold thickness, and upper arm muscle and fat areas are reported for children 0-10.9 years of age. Like other Amazonian Amerindians, Tupí-Mondê children are short for their age but normal or above normal in weight for height with respect to the National Center for Health Statistics reference. Hence stunting levels are high (55.4%) and wasting levels are low (0.8%). There are also deficits in body composition parameters, especially in upper arm circumference and estimated muscle and fat areas. We interpret the results as evidence of suboptimal nutritional status, reflecting the interaction between poor diet and infectious and parasitic diseases. The Gavi?o, with the longest period of contact, present the lowest level of stunting. This finding is attributed to the use of cash income from rubber tapping and nut gathering to purchase of food items and health care. Differences in height between the three groups are mostly due to leg length, instead of sitting height, reinforcing the idea that environmental conditions can alter body proportions.     

Standards of arm muscle by stature for the assessment of nutritional status of children

This study is based on a sample of 9,134 children ranging in age from 2 to 17 years from which the excessively lean and fat children by skinfold thickness were excluded. This sample was derived from the combined data sets of the first and second National Health and Nutrition Examination Surveys (NHANES I and II) of 1971-1974 and 1976-1980. Means and percentiles of upper arm muscle area were calculated for 3 cm increments in stature from 84 to 184 cm for boys and from 84 to 176 cm for girls. Based on means, Z-score units, and percentile ranges of upper arm muscle area by stature, five operational categories of nutritional status have been established. It is recommended that these standards and this classification system be used to supplement current standards of weight for age and weight for height in order to obtain a more complete assessment of body composition and nutritional status.     

Estimating height from arm span measurement in Malawian children

Arm span and standing height were measured in 289 boys and 337 girls aged 6-15 years who were free from physical deformities which can affect stature or arm span. The arm span exceeded height in all age groups of boys and in older girls. At the age of 7, 11 and 12 years girls were significantly taller than the boys and had longer arm span while at the age of 15 years, the trend was opposite. The mean difference between the two anthropometric parameters for boys was 5.45 +/- 4.21 cm (t = 3.556, p < 0.001) and for girls was 4.94 +/- 4.96 cm (t = 3.542, p < 0.001). Correlation coefficient between height and arm span measurements for Malawian boys was 0.983 and for girls was 0.986. Height, arm span and height-arm span difference increased with age of children while height to arm span ratio decreased. The gender difference in height-arm span differences was only significant at the age of 15 years. Multiple regression and cross validation were performed. Height of Malawian children of both sexes can be estimated from equation: Height (cm) = 15.756 + (0.168 x age) + (0.839 x arm span) (SEE = 0.760, R2 = 0.988).     

Growth and nutritional status of the Bharia--a primitive tribe of Madhya Pradesh

This study is an attempt to understand the physical growth and nutritional status of Bharia, a primitive tribe of Central India. A cross sectional study was conducted on 551 children (283 boys and 268 girls) aged 4 to 18 years. Body weight, height, sitting height, head circumference, upper arm circumference, chest circumference, biceps, triceps, sub scapular and calf skin fold thickness were measured. Body Mass Index was calculated as weight/height2 to calculate chronic energy deficiency. All anthropometric measurements except skin fold measurement exhibit uniform increase with age in both the sexes. Age-specific Body Mass Index (BMI) indicated substantial changes and falls during pre-school age and rise in adolescence. The BMI according to the Indian standard was normal, but when the data was compared with the International standard malnutrition in both sexes was noticed in childhood. Boys remained undernourished after adolescence, while girls reached the normal growth patterns.     

A case of Silver-Russell syndrome (SRS): multiple pituitary hormone deficiency,lack of H19 hypomethylation and favourable growth hormone (GH) treatment response

Hypomethylation of the imprinting control region 1 (ICR1) at the IGF2/H19 locus on 11p15 is linked to Silver-Russell syndrome (SRS) and/or hemihypertrophy. This SRS patient was born in term with weight of 3500 g (50 percentile) and length 48 cm (>1 SD below the mean). He was first noticed at the age of 10 years for short stature (114.5 cm, −3.85 SD), relatively normal head circumference, a classic facial phenotype, hemihypertrophy (2.5 cm thinner left arm and leg in comparison to the right, asymmetric face), moderate clinodactyly and striking thinness (BMI of 15.3). At the age of 30, the body asymmetry ameliorated (1 cm thinner left arm and leg than the right), and BMI normalized (20.5 cm). Methylation analysis was performed by bisulphate treatment of DNA samples, radiolabelled PCR amplification, and digestion of the PCR products using restriction enzymes. The patient had normomethylation, and in addition hypopituitarism, with low levels of growth hormone (GH) (provocative testing before the start and after termination of GH treatment), thyroxin, TSH, FSH, LH and testosterone. The GH was given for six years, growth response was satisfactory and he reached an adult height of 166 cm. This is a first report of hypopituitarism in a patient with SRS without H19 hypomethylation. It seems that the lack of hypomethylation in this hypopituitary SRS patient is responsible, at least partly, for the favourable final adult height under GH treatment.     

Evaluation of the relative rates of bone mineral content loss in postmenopause due to both estrogen deficiency and ageing

To evaluate the relative rates of bone mineral content loss in postmenopause due to both estrogen deficiency and ageing, three groups of women were studied by computerized bone densitometry at the radius mid-point and at the distal point, modified according to the Abwrey technique. All women were in apparent good health and never had estrogen therapy. In the first group there were 64 women aged between 30 and 50 who were ovariectomized between 25 and 35 years of age. The second group was made up of 309 women between 50 and 55 years. In the third group there were 136 women aged 30-50 with normal ovaric function. The ordinary functions of linear polynomial regression were used to describe the variations in density with age. The percentage of postmenopausal bone loss was determined by calculating the BMC value at the start of the menopause and again twenty years later, according to the linear regression equation of postmenopausal period of each group of women in the study. The women who had natural menopause showed an average bone loss per year of 1.63% at the mid radius and 1.0% at the distal point. The ovariectomized women had an average loss of 0.85% at the mid point and 0.66% at the distal point. No significant decrease of bone mass was found before menopause. From a comparison between the two groups of women with analogous periods of menopause, it comes out that, during the first 20 years of natural menopause, estrogen deficiency is responsible for 52.5%-66.4% of the bone mineral loss, the remaining amount being attributable to other causes, connected with ageing. Estrogen deficiency is therefore, the principal factor causing bone mineral loss in natural menopause.     

Effect of Ascaris infection on the nutritional status and I.Q. of children

It was estimated that about 1.3 billion persons all over the world were infected with Ascaris Lumbricoides (A.L.), Especially children in tropical and subtropical countries. AIM To investigate the effects of A.L. infection on the nutritional status and the intellectual level in a sample of Egyptian primary school children from rural Giza province. SUBJECTS AND METHODS A sample of 637 children (329 boys and 308 girls) aged 6–12 years, have been subjected to some anthropometric measurements including body weight, body height, arm circumference, head circumference and triceps skinfold thickness. In addition, the I.Q. was determined using “Draw-a-man” test. Blood hemoglobin concentration was also determined using a spectrophotometric method. All the children were then subjected to stools and urine examinations, and peri-anal swab. Only 242 children were included for further study, of whom 45 boys and 38 girls were found infected with A.L. solely, and 81 boys and 78 girls of about the same age free of parasitic infections were taken as control. RESULTS Children infected with A.L. has significantly lower body weight, height, and arm circumference but insignificantly lower skinfold thickness and head circumference as comparedto the control group. Infected children had significantly lower hemoglobin concentration and I.Q. than the controls. CONCLUSIONS Selected anthropometric measurements, biochemical and intellectual tests from a useful complementary battery for reliable and informative investigation of the effects of parasitic infection on child nutrition and health. A.L. was found to have a significant effect on the physical and intellectual status of the rural Egyptian children of age 6–12 years.     

Influence of central and extremity circumferences on all-cause mortality in men and women

For a given level of adiposity, greater lower body circumferences appear to exert a protective effect on several disease outcomes including cardiovascular disease and diabetes; however, the independent associations between extremity circumferences and mortality have not been widely investigated. The purpose of this study was to determine the independent and shared influences of upper- and lower-body circumferences on the risk of mortality in a population-based sample of adults. The sample included 10,638 adults 20-69 years of age (5,012 men; 5,626 women) from the nationally representative 1981 Canada Fitness Survey (CFS), who were monitored for over 12 years for mortality. BMI was calculated from measured height and weight. Waist, hip, thigh, calf, and upper arm circumferences were measured using a flexible, nonelastic anthropometric tape. Sex-specific proportional hazards regression models were used to evaluate the relationship between standardized values (Z-scores) of extremity circumference measures, waist circumference (WC) and mortality. Age, smoking status, alcohol consumption, and leisure-time physical activity were collected by questionnaire and were included as covariates. During 131,563 person-years of follow-up, there were 340 deaths in men and 231 in women. After mutual adjustment, WC was positively associated with mortality whereas arm, thigh, and calf circumferences were significantly protective in men, and arm and thigh circumferences were protective in women. In conclusion, waist and extremity circumferences appear to have opposite, independent effects on mortality in this sample of Canadians. Independent of BMI and WC, men and women with larger extremity circumferences had a lower risk of mortality.     

Menopause in Blackfeet women--a life span perspective

A lifespan perspective, combining quantitative and qualitative approaches, is used to examine factors related to the timing of menopause in Blackfeet women of northern Montana (USA). Cross-sectional survey data demonstrate a median age at menopause using a status quo method of 51.6 years, and a mean age of 47.0 +/- 5.0 years among those women who had already experienced menopause. Age at menopause is inversely associated with age at menarche and having been breastfed, and positively associated with use of contraceptives, household income, and current or recent employment. Household income and age at menarche influence menopause age jointly in multivariate models. These and other patterns are examined in the lives of two women with very divergent ages at menopause. Although these data support an effect of early life influences on shaping reproductive trajectories that culminate in menopause, environmental factors and human agency during adult life may play a modifying role.     

Trends in Waist Circumference among U.S. Adults

Objective: Waist circumference has been proposed as a measure of obesity or as an adjunct to other anthropometric measures to determine obesity. Our objective was to examine temporal trends in waist circumference among adults in the U.S. Research Methods and Procedures: We used data from 15, 454 participants ≥20 years old in National Health and Nutrition Examination Survey (NHANES) III (1988 to 1994) and 4024 participants ≥20 years old from National Health and Nutrition Examination Survey 1999 to 2000. Results: The unadjusted waist circumference increased from 95.3 (age‐adjusted, 96.0 cm) to 98.6 (age‐adjusted, 98.9 cm) cm among men and from 88.7 (age‐adjusted 88.9 cm) to 92.2 (age‐adjusted 92.1 cm) cm among women. The percentiles from the two surveys suggest that much of the waist circumference distribution has shifted. Statistically significant increases occurred among all age groups and racial or ethnic groups except men 30 to 59 years old, women 40 to 59 and ≥70 years old, and women who were Mexican American or of “other” race or ethnicity. Discussion: These results demonstrate the rapid increase in obesity, especially abdominal obesity, among U.S. adults. Unless measures are taken to slow the increase in or reverse the course of the obesity epidemic, the burden of obesity‐associated morbidity and mortality in the U.S. can be expected to increase substantially in future years.     

Physical growth and nutritional status of Car Nicobarese and Moplah children of Andaman–Nicobar Islands in India

The objective of this cross-sectional study was to assess growth and nutritional status of Car Nicobarese children and compare it with Moplah children, who live in a similar environment. A total of 436 Car Nicobarese children and 438 Moplah children, aged 6–10 years, were selected for the study. The anthropometric measurements included stature, body weight, sitting height, bi-acromial breadth, bi-iliac breadth, mid-upper arm circumference, skinfold thickness of biceps, triceps and subscapular region. 50th percentile (median) growth curves were calculated among the studied children and compared with Centers for Disease Control and Prevention (CDC) 2000 reference. Z scores of weight for age (WAZ), height for age (HAZ) and BMI for age (BMIZ) were computed using growth references of the CDC 2000.It was observed that the Car Nicobarese children were shorter but heavier than Moplah children of both sexes all through the age range, which was also reflected in median value of anthropometric variables. Car Nicobarese children were nutritionally better compared to Moplah children based on the nutritional indices. The major differences between Car Nicobarese and Moplah children were found in their arm muscularity rather than arm adiposity. Overall, Car Nicobarese children were nutritionally in normal and better condition than Moplah children. However, present dietary change (intake of high calories and fat diet) of Car Nicobarese population may be reflected in the form of childhood obesity in the recent future, which has already been observed in their adult population.     

Impact of social class on body fatness among rural pre-school Bengalee Hindu children of Arambagh, West Bengal, India

Body composition is a useful marker for assessing the adiposity of an individual. The amount of body fat (BF) differs with age, sex, environmental conditions and genotype, and is a good indicator of the health and nutritional status of a community. As the subcutaneous fat serves as a reservoir for energy during nutritional deprivation, lower BF in comparison with other studies indicates a lower energy intake by those children, who are affected by their lower socio-economic status. The objective of the present study was to evaluate the impact of socio-economic class, after allowing for sex and age, on body fatness among rural pre-school children of Bengalee Hindu ethnicity of Arambagh, West Bengal, India. The present study was undertaken at 20 Integrated Child Development Services (ICDS) scheme centers in Bali Gram Panchayat, Arambagh, Hooghly District of West Bengal, India. A total of 1012 boys and girls (aged 2-6 years) living in these areas were studied. The children were classified into two groups based on their social class: Schedule Castes (SC) and Non-Schedule Castes (NSC). In general, SC comprise socio-economically and educationally deprived individuals. Three-way analysis of variance was used to assess the effect of ethnicity on mid-upper arm circumference (MUAC) and sum of skinfolds (SS), allowing for age and sex. There was an increasing age trend in both these variables in both sexes in the two groups. All three factors had a significant effect on MUAC, whereas only age and social class had a significant impact on SS. In the case of MUAC, only one second order interaction (sex-age) was significant. In conclusion, we found that after controlling for age and sex, children belonging to the SC group had lower body fatness. These results implied that they were under more nutritional stress. There was also some evidence that at the early ages, girls belonging to the SC group probably received inadequate nutrition and as a result had lower body fat.     

Anthropometric data in middle-aged women. The population study of women in G?teborg 1968-1969.

Body weight, body height, skinfolds, circumferences and weight indices in a population sample of 1462 women in ages between 38 and 60 years are presented. Significant age differences were noted. High correlations (r) were found between body weight and triceps and subscapular skinfolds (0.62 and 0.72 respectively) and between body weight and arm, waist and buttock circumferences (0.75-0.88). Age differences were mostly noted between 46 and 50 years of age. After that age there was a comparatively greater increase of the waist circumference than of the buttock circumference, while triceps skinfold seemed to decrease after the age of 50 indicating an altered adipose tissue distribution from the extremities to the trunk with increasing age. When taking data from a previous study of body weight in the same population of women into consideration it seems that the age differences in body weight found in cross-sectional study like the present one may to a large extent depend on differences between different cohorts studied.     

Apoptosis in ovarian cells in postmenopausal women

Apoptosis is a natural process which accompanies human ovary from the moment of birth until old age. While it is a well-known process at the reproductive age, it still needs to be thoroughly examined when referring to the postmenopausal age. The study involved 30 postmenopausal women who had their ovaries removed by laparotomy due to nonneoplastic diseases of the uterus. The women were divided into 3 groups depending on the time that had passed since the last menstruation. Group A consisted of women who had their last menstruation no more than 5 years earlier. In group B menopause occurred 5 to 10 years earlier. Group C was composed of patients who had the last menstruation over 10 years earlier. In all the patients concentrations of follitropin (FSH) and estradiol (E2) in blood plasma were measured. Ovarian tissue was obtained during surgery. For morphological studies, ovaries were fixed in Bouin's solution and 4% formalin and embedded in paraffin. Morphological analysis was carried out after hematoxylin-eosin (H-E) staining. For histochemical detection of apoptotic cells (in situ localization of fragment DNA), the TUNEL method was used. The expression of caspase-3 positive cells was determined immunohistochemically in paraffin-embedded specimens. Comparing to groups A and B, the ovaries in group C contained small number of corpora albicantia located in the medullary part as well as thinned blood vessels and few lymphatic vessels and nerves. In contrast to group A where the number of TUNEL-positive cells was high and caspase-3 expression was observed, no TUNEL-positive nuclei and caspase-3 expression were found in the examined ovaries of group C women.     

Oral contraceptives and fat patterning in young adult women

90 nulliparous white female college students, selected from 2 undergraduate introductory courses at Kansas University, participated in a cross-sectional study designed to compare the fat distribution of oral contraceptive (OC) users to that of nonusers matched for height and weight. The subjects ranged in age from 18-26 years. The 30 OC users had been using the same brand of OCs for an average of 17.7 months (range of 3-36 months) and had not used another brand previously. Each OC user was matched to 2 nonusers. Each subject's height was measured to the nearest cm. A Detecto sliding-weight balance was used to measure body weights of the women (in light clothing) to the nearest 0.1 kg. Circumference measurements also were taken to determine body shape and fat distribution. The waist girth to hip ratio (WHR) also was calculated. Fat distribution of the OC users was similar to that of nonusers matched for height and weight. Both groups were comparable in their circumference and skinfold measurements, except that the OC users had larger axilla skinfolds. Progestational activity of the combined OCs was not associated with any of the physical measurements. Estrogenic activity of the combined OCs was correlated positively with body mass index, arm and thigh circumference, and peripheral fat distribution. Estrogenic activity also was associated weakly with hip and low chest circumferences but no with any of the 7 skinfold thickness measurements. The women taking the higher estrogen OCs were more likely to have circumference measurements consistent with a more gynoid shape. Thigh skinfold thickness was consistent with those findings, though not statistically significant.     

Nutritional status and dietary habits of urban and rural Polish adolescents

The aim of this work was to compare the basic food ingredient level and some nutritional status indices between the two groups of adolescents: the first one from the urban environment and the other one from the rural environment. A series of tests were conducted on a 400-teenager-group (200 girls and 200 boys), which was divided into two age groups: 10.5-year-olds and 13.5-year-olds. Nutritional status was estimated on the basis of the following anthropometric measurements: body height, body mass index, upper arm circumference, triceps skinfold thickness. Food intake was assessed by means of a 24-h dietary recall. The analysis of the results of the investigation showed: rare overweight and obesity occur in rural children aged 10.5 years and a higher risk of undernutrition among rural children, especially boys; more frequent overweight and obesity in rural girls and urban boys aged 13.5 years; a lower protein consumption, especially animal protein, and a lower percentage of the accomplishment of the norm for many mineral components and vitamins in rural girls and boys.     

Gender bias in the effects of arms and countermovement on jumping performance

The ability to jump high is considered important in a number of sports. It is commonly accepted that the use of the arms and a counter movement increase jump height. In some sport situations (e.g., volley ball block, basketball rebound), athletes may not be able to utilize a counter movement or arm swing. The purpose of this study is to examine gender differences in the contribution of the arm swing and counter movement to vertical jump height. Fifty college students, 25 men (age = 21.4 +/- 1.7 years, height = 182.2 +/- 8 cm, weight = 83.7 +/- 12.4 kg) and 25 women (age = 20.7 +/- 1.6 years, height = 166.7 +/- 6.3 cm, weight = 61.5 +/- 7.0 kg), performed 4 jumping movements: squat jumps with hands on hips (SNA), counter movement jump with hands on hips (CMNA), squat jump with arm swing (SA), and counter movement with arm swing (CMA). Significant differences were found between men's and women's performance, as well as between each type of jump within each gender. A mixed-model analysis of variance detected gender differences with respect to changes in the jumping movement. For both sexes the jumps in order from worst to best were SNA, CMNA, SA, and CMA. Peak power values for men were 4,057, 4,020, 4,644, and 4,747 W, respectively, for the 4 jumps. The female power values were 2,543, 2,445, 2,842, and 2,788 W, respectively, for the 4 jumps. Arms increased jump height more than a counter movement for both genders, with jump heights for men at 29.6, 31, 36, and 38 cm, respectively, and those of women 21, 22, 26, and 27 cm, respectively. Use of the arms was found to increase the jump height of the men significantly more than that of women. Changes in jumping movements affect men and women differently. The greater increase in jump height for the men when using the arm swing could be because of greater upper body strength of men compared with women. This could have applications to training and upper body strength and also to modeling of jumping movements.     

Final height of growth hormone-treated GH-deficient children and girls with Turner's syndrome: the Dutch experience. The Dutch Advisory Group on Growth Hormone

In the Dutch growth hormone (GH) registration database there are currently 552 GH-deficient children being treated, subcutaneously, with recombinant human GH six to seven times per week. Of those, 112 who have been treated for at least 2 years have reached final height. Mean age at start of therapy was 11.70 years. Mean GH dose was 15.5 IU/m(2) body surface per week. Mean final height was 173.2 cm (boys) and 159.7 cm (girls) and -1.36 SD of the population mean. Of the patients, 73.2% and 63.4%, respectively, reached a final height above -2 SD of the population or within target limits. FH-SDS was higher compared with the results of earlier cohorts with different treatment regimens. Target height, GH peak value at diagnosis, age at start of GH therapy, height SDS (HSDS) at start of puberty, and duration of GH therapy were significantly correlated with final height. These results, combined with those of a prospective GH dose-response study, suggest that better long-term results can be obtained with early and prolonged treatment and if the GH dose is individually adapted to the short-term growth response. In an ongoing dose-response study, 68 girls with Turner's syndrome, aged 2-11 years, were randomized into three dosage groups with a daily GH dose of: (group A) 4 IU/m(2) body surface; (group B) 4 IU/m(2) in the first year of therapy and 6 IU/m(2) thereafter; (group C) 4 IU/m(2) in the first year, 6 IU/m(2) in the second year, and 8 IU/m(2) thereafter. After 4 years of GH therapy, girls aged 12 years or older started low-dose oestrogen therapy. After 7 years of GH therapy, mean HSDS in all three groups had increased to values above the third percentile for healthy girls. Mean final height and final height gain of 25 girls was 159.1 and 12.5 cm, 161.8 and 14.6 cm, and 162.7 and 16.0 cm in groups A, B and C respectively. These long-term and final height results are more favourable than the results of earlier Dutch Turner's syndrome studies. Possible explanations are the higher GH doses and/or the younger age at start of GH therapy.