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1.
Work requiring extremely body flexion is strongly associated with a high incidence of musculoskeletal injuries often reported during adopting squatting. In this study, the influence of different lower seat heights on the muscular stress in squatting on a stool (SS) were examined in comparison with fully squatting (FS). Fourteen healthy Indonesian males were recruited in the experiment. Two-dimensional body kinematics, ground reaction force (GRF) and electromyography (EMG) data were collected as subjects performed forward movement under four squatting height conditions which were FS and SS at 10 cm, 15 cm and 20 cm seat height. The results demonstrated that the change from FS to SS primarily affected the segmental angular flexions and muscular activities in the upper and lower limbs. GRF data showed that the SS conditions delivered 24% body weight onto the seat. The change of FS to SS showed significantly decrease in muscular load of the rectus femoris and tibialis anterior. In contrast, the soleus and gastrocnemius increased the activities as the seat height increased. The type of task that required the hand to handle the object on the ground level affected the trunk to be more flexed as the seat height increased. The findings of this study suggest that the use of a lower seat stool of a proper height seems to be a sub-optimal solution considering the change of muscular load associated with the discomfort in a squatting posture.  相似文献   

2.
The effect of weight, classified by body mass index (BMI), on bone mass (BMC) of the whole body and on bone mineral density BMD of the hip joint was analysed in a sample of 120 Austrians of Vienna and surroundings. The 68 females and 52 males of this cross sectional study ranged in age between 60 and 92 years (x = 71.7 +/- 7.7). Age distribution was not significantly different between sexes. The WHO (1997) classification of body mass index (BMI) was used for weight classification, i.e. normal weight (BMI 18.5-24.99) and moderate overweight (BMI 25.0-29.99). Obese subjects (BMI 30+) were not included in this study. Bone mass of the whole body as well as bone density of the hip joint were determined by Dual-energy-X-ray absorptiometry (DEXA) using a hologic 2000 scanner. As expected BMC and BMD values were significantly higher in males than in females. While in both females and males moderately overweight BMD of the hip was significantly higher than in those with normal BMI, statistically significant differences of BMC were restricted to females only. Such positive association between body weight and BMC and BMD is in agreement with previous studies on mature subjects, and menopausal and postmenopausal women in particular. In addition, this study demonstrates corresponding positive associations between moderate overweight and bone mass and -density in the elderly and old aged.  相似文献   

3.
Objective: This study evaluated associations of telomere length with various anthropometric indices of general and abdominal obesity, as well as weight change. Design and Methods: The study included 2,912 Chinese women aged 40‐70 years. Monochrome multiplex quantitative polymerase chain reaction was applied to measure relative telomere length. Results: Telomere length was inversely associated with body mass index (BMI), waist circumference, waist‐to‐height ratio, weight, and hip circumference (Ptrend = 0.005, 0.004, 0.004, 0.010, and 0.026, respectively), but not waist‐to‐hip ratio (Ptrend = 0.116) or height (Ptrend = 0.675). Weight change since age 50 was further evaluated among women over age 55. Women who maintained their weight within ±5% since age 50, particularly within a normal range (BMI = 18.5‐24.9 kg/m2), or reduced their weight from overweight (BMI = 25‐29.9 kg/m2) or obesity (BMI ≥30 kg/m2) to normal range, had a longer mean of current telomere length than women who gained weight since age 50 (Ptrend = 0.025), particularly those who stayed in obesity or gained weight from normal range or overweight to obesity (P = 0.023). Conclusion: Our findings show that telomere shortening is associated with obesity and that maintaining body weight within a normal range helps maintain telomere length.  相似文献   

4.
Objective: The goal was to estimate the prevalence of overweight, obesity, underweight, and abdominal obesity among the adult population of Iran. Research Methods and Procedures: A nationwide cross‐sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Weight, height, and waist circumference (WC) of 89,404 men and women 15 to 65 years of age (mean, 39.2 years) were measured. The criteria for underweight, normal‐weight, overweight, and Class I, II, and III obesity were BMI <18.5, 18.5 to 24.9, 25 to 29.9, 30 to 34.9, 35 to 39.9, and ≥40 (kg/m2), respectively. Abdominal obesity was defined as WC ≥102 cm in men and ≥88 cm in women. Results: The age‐adjusted means for BMI and WC were 24.6 kg/m2 in men and 26.5 kg/m2 in women and 86.6 cm in men and 89.6 cm in women, respectively. The age‐adjusted prevalence of overweight or obesity (BMI ≥25) was 42.8% in men and 57.0% in women; 11.1% of men and 25.2% of women were obese (BMI ≥30), while 6.3% of men and 5.2% of women were underweight. Age, low physical activity, low educational attainment, marriage, and residence in urban areas were strongly associated with obesity. Abdominal obesity was more common among women than men (54.5% vs. 12.9%) and greater with older age. Discussion: Excess body weight appears to be common in Iran. More women than men present with overweight and abdominal obesity. Prevention and treatment strategies are urgently needed to address the health burden of obesity.  相似文献   

5.
Objective: Although a growing body of literature has found unrealistic weight loss goals to be common among older, primarily female, subjects, little is known about weight loss goals of younger adults. Research Methods and Procedures: Three hundred seventy‐nine college students had their height and weight taken and reported their “goal,” “dream,” “happy,” “acceptable,” and “disappointed” weights. A series of 2 (gender) × 2 (nonoverweight vs. overweight) ANOVAs were conducted with both absolute weight goals and percentage of weight loss needed to obtain those goals as dependent variables. Results: When examined in terms of absolute weight goals, women generally had lower body mass index (BMI) goals than men, and nonoverweight participants had lower BMI goals than overweight participants. Surprisingly, most overweight participants would accept a weight loss that would still place them in the overweight BMI range. When examined in terms of percentage loss needed to reach those goals, only overweight women chose goal and dream weights that would require a loss greater than can be expected from nonsurgical weight‐loss treatments, and all overweight participants chose happy and acceptable weights within 15% of current weight. Discussion: Participants in this study had generally reasonable weight‐loss goals, and even the most extreme weight loss goals were much more moderate than those found in previous studies. These results are surprising given the extreme social pressures for thinness facing young adults. Future studies should examine the variables that influence selection of goal weights and how goal weights affect actual dieting behavior.  相似文献   

6.
Load carriage is a very common daily activity at home and in the workplace. Generally, the load is in the form of an external load carried by an individual, it could also be the excessive body mass carried by an overweight individual. To quantify the effects of carrying extra weight, whether in the form of an external load or excess body mass, motion capture data were generated for a diverse subject set. This consisted of twenty-three subjects generating one hundred fifteen trials for each loading condition. This study applied principal component analysis (PCA) to motion capture data in order to analyze the lower body gait patterns for four loading conditions: normal weight unloaded, normal weight loaded, overweight unloaded and overweight loaded.PCA has been shown to be a powerful tool for analyzing complex gait data. In this analysis, it is shown that in order to quantify the effects of external loads and/or for both normal weight and overweight subjects, the first principal component (PC1) is needed. For the work in this paper, PCs were generated from lower body joint angle data. The PC1 of the hip angle and PC1 of the ankle angle are shown to be an indicator of external load and BMI effects on temporal gait data.  相似文献   

7.
The emerging concept that various fat compartments are metabolically active and play separate and decisive roles in the pathogenesis of coronary atherosclerosis, hypertension, insulin resistance, diabetes and stroke, has given obesity research a new direction. Of particular interest is the relative amount of intra-abdominal fat thought to be responsible for the metabolic complications. We studied the precise fat distribution and its correlations with the metabolic parameters in 44 non-human primates (Macaca fascicularis). Intra-abdominal, subcutaneous, and total abdominal fat (IAF, SAF, TAF) were assessed by magnetic resonance imaging (MRI) and somatometry. Quantitative computer analyses of abdominal MRI scans revealed predominant IAF distribution. Box plot analysis of IAF and SAF revealed wide diversity in the amounts of fat, especially in monkeys with body mass index (BMI) <30 kg/m2. Primates with similar BMI in each quartile revealed an extensive heterogeneity in IAF as well as SAF. Numerous significant correlations within site-specific somatometric measurements as well as within the MRI determinants of abdominal fat were seen. However, only body weight correlated with IAF and skinfolds could predict SAF. After adjusting for body weight, partial correlation analysis showed a significant correlation (P<0.05) between total cholesterol and IAF. Conclusion: MRI revealed considerable heterogeneity of IAF, SAF and TAF in a cohort of primates believed to be homogeneous by somatometric definition. Male cynomolgus monkeys appear to be a valuable model for a systematic evaluation of fat. Individuals with identical body weight and height may show a diverse pattern of fat distribution.  相似文献   

8.
OBJECTIVE: The present investigation was aimed to evaluate the effect of subclinical hypothyroidism and obesity on bone mineral content (BMC) in different body segments. METHODS: Thirty-two premenopausal women (age: 37 +/- 9.9 years), with a wide range in body mass index (BMI), were studied. Subclinical hypothyroidism was defined by a basal TSH > or = 4 microU/l and/or a TRH-stimulated peak > or = 30 microU/l. For each subject, weight, height, BMI (weight/height(2)) and the waist/hip ratio were measured. Total BMC, total bone mineral density (BMD), leg BMC, leg BMD, trunk BMC, trunk BMD, arm BMC and arm BMD were determined using dual-energy X-ray absorptiometry. Thyroid function (basal and TRH-stimulated TSH, free T(3) and free T(4)) were determined from fasting blood samples for all subjects. RESULTS: Anova was conducted within all the groups to observe the effect of thyroid status and/or obesity on BMC and BMD. There was no statistical difference for age. Total BMC was affected by obesity (p < 0.05) but not by thyroid status, BMD of the legs was significantly influenced both by thyroid function and obesity (p < 0.01); total BMD was affected by hypothyroid status (p < 0.05). A direct relationship between leg BMD and TSH was demonstrated. CONCLUSION: Subclinical thyroid hypofunction and obesity seem to affect BMD differently in the body segments. An influence of gravitational force seems necessary in order to make evident the effect of subclinical hypothyroidism on bone. A condition of subclinical hypothyroidism should be considered when evaluating subjects for osteoporosis, since a BMD measured at the femoral neck may induce underestimation of initial osteoporosis.  相似文献   

9.
To examine the associations between birth weight and BMI, and total body composition, in overweight Latino adolescents. Two hundred and forty-two overweight Latino children (baseline age = 11.1 +/- 1.7 years; BMI >or= 85th percentile) were measured annually for up to 6 years (2.6 +/- 1.4 observations/child, total 848 visits). Birth weight and history of gestational diabetes were obtained by parental interview. Visceral fat and subcutaneous abdominal fat were assessed by magnetic resonance imaging, while total body fat, total lean tissue mass (LTM), trunk fat, and lean tissue trunk mass were measured by dual-energy X-ray absorptiometry. BMI and BMI percentile were calculated using the Centers for Disease Control and Prevention age appropriate cutoffs. Longitudinal linear mixed effects (LME) modeling was used to evaluate the influence of birth weight on subsequent changes in body composition and distribution of fat across puberty. Birth weight significantly predicted BMI (P < 0.001), total trunk fat (P < 0.001), total trunk LTM (P < 0.001), total fat mass (FM) (P < 0.001), and total LTM (P < 0.001), but not subcutaneous (P = 0.534) or visceral fat (P = 0.593) at age 11 years. Longitudinally, as participants transitioned into puberty, birth weight did not significantly predict any of the body composition or fat distribution measures (P > 0.05). Birth weight is significantly associated with increased adiposity and LTM and negatively associated with trunk fat mass and trunk lean mass at baseline; however these relationships did not predict rate of change of any of the variables as the children progress through adolescence.  相似文献   

10.
In order to assess overweight in urban schoolchildren (298 boys and 298 girls) aged 9-16 years in Dalian, China, their body height, weight, skinfolds at triceps, biceps, subscapular and suprailiac, and body circumferences of mid-upper arm, waist and hip were measured. The results showed that the prevalence of overweight, based on the United States Centers for Disease Control 2000 reference values using body mass index (BMI), was 22.9% in boys and 10.4% in girls, which was higher than that of indicated in Chinese national surveys of recent decades. More boys were overweight than girls due to excessive increase in body fat, although the prevalence of overweight in girls prevalence increased from 13 years. Discussion here focuses on the effects of behavioral patterns on overweight in Dalian schoolchildren, paying attention to gender difference.  相似文献   

11.
The bodyweight squat is a common movement and is safe and effective. There are many variations and techniques, but little research has explored alterations of the movement. The purpose of this study was to examine the effects of 2 arm positions on select kinematic variables during the bodyweight squat. The participants were classified as normal-weight (NW: n = 17, height: 1.67 ± 0.06 m, weight: 61.25 ± 6.90 kg, body mass index [BMI]: 21.92 ± 1.68) or overweight (OW: n = 11, height: 1.68 ± 0.06 m, weight: 88.91 ± 16.86 kg, BMI: 31.64 ± 6.06) according to BMI. The participants completed a bodyweight squat with the arms held at the sides (AP1) followed by a bodyweight squat with the arms held at shoulder level (AP2). Reflective markers were placed on the shoulder, hip, knee, base of the fifth toe, and heel. Data were recorded and analyzed using Peak 9. Trunk and knee flexion was analyzed using separate repeated measures analyses of variance. Overweight participants exhibited reduced knee (OW: 75.56 ± 17.94°; NW: 83.73 ± 13.03°; p < 0.05) and trunk flexion (OW: -78.18 ± 17.72°; NW: -90.65 ± 17.57°; p = 0.05). Holding the arms at shoulder level resulted in greater knee flexion (AP1: 80.81 ± 15.17°; AP2: 86.31 ± 15.21°; p < 0.01). Both weight status and arm position affected the range of motion in the bodyweight squat. Using an arms-up position should be considered, especially for the OW population, to increase the benefits of the bodyweight squat by increasing the range of motion.  相似文献   

12.
Objectives : Although BMI (kilograms per meter squared) is widely used as a surrogate measure of adiposity, it is moderately associated (r ~ 0.3) with height among children. We examined whether the resulting preferential classification of taller children as overweight, based on a BMI ≥95th percentile, is appropriate. Research Methods and Procedures : We assessed the cross‐sectional relation of height among 5‐ to 18‐year‐old subjects (n = 1180) to levels of BMI, the sum of 10 skinfold thicknesses, and percentage body fat as determined by DXA. Results : The prevalence of a BMI level ≥95th percentile was substantially higher among 5‐ to 11‐year‐old subjects who were relatively tall for their age than among shorter children. Among 5‐ to 8‐year‐old boys, for example, each SD increase in height‐for‐age was associated with a 4.6‐fold increase in the prevalence of overweight (p < 0.001). Height not only was associated with BMI but also showed similar correlations with the skinfold sum and with percentage body fat; furthermore, the magnitudes of these associations decreased with age. We also found that the association between percentage body fat and BMI (r = 0.85 to 0.90) was close to the maximum correlation that can be achieved by any weight‐height index. Discussion : The use of BMI, which preferentially classifies taller young children as overweight, is appropriate because height and adiposity are correlated before the age of 12 years.  相似文献   

13.
Objective: The objective of this study was to investigate changes in body weight, BMI, body composition, and fat distribution among freshman women during their 1st year of college. Research Methods and Procedures: Freshman women during the 2004 to 2005 academic year were recruited to participate. The initial baseline visit occurred within the first 6 weeks of the fall 2004 semester, with the follow‐up visit occurring during the last 6 weeks of the spring 2005 semester. At each visit, height, weight, BMI, waist and hip circumferences, and body composition (by DXA) were obtained. Results: One hundred thirty‐seven participants completed both the fall and spring visits. Significant (p < 0.0001) increases between the fall and spring visits were observed for body weight (58.6 vs. 59.6 kg), BMI (21.9 vs. 22.3), percentage body fat (28.9 vs. 29.7), total fat mass (16.9 vs. 17.7 kg), fat‐free mass (38.1 vs. 38.4 kg), waist circumference (69.4 vs. 70.3 cm), and hip circumference (97.4 vs. 98.6 cm), with no significant difference observed in the waist‐to‐hip ratio (0.71 vs. 0.71; p = 0.78). Discussion: Although statistically significant, changes in body weight, body composition, and fat mass were modest for women during their freshman year of college. These results do not support the purported “freshman 15” weight gain publicized in the popular media.  相似文献   

14.
Objective: To examine temporal trends in stature, body mass, body mass index (BMI), and the prevalence of overweight and obesity in Canada. Research Methods and Procedures: Data for adults 20 to 64 years of age were compared across eight Canadian surveys conducted between 1953 and 1998. Temporal trends in stature and body mass were examined using regression, and changes in weight‐for‐height were expressed as changes from 1953. BMI data were available from 1970 to 1972 to examine changes in overweight and obesity. Qualitative changes in the BMI distribution were examined using Tukey mean‐difference plots. Results: Significant temporal trends in stature and body mass have occurred since 1953 in Canada. Median stature increased 1.4 cm/decade in men and 1.1 cm/decade in women, whereas median body mass increased 1.9 kg/decade in men and 0.8 kg/decade in women. Increases in the 75th percentile of body mass were larger than the median. The average weight‐for‐height increased 5.1% in men and 4.9% in women from 1953. Furthermore, the prevalences of overweight and obesity have increased from 40.0% and 9.7% in 1970–1972 to 50.7% and 14.9% in 1998, respectively. The entire BMI distribution has shifted to the right since 1970–1972 and has become more skewed to the right for men than for women. Discussion: There have been significant increases in stature and body mass in Canada over the last 45 years. Body mass has increased more than stature, particularly in the upper percentiles, which has resulted in the currently observed high prevalences of overweight and obesity.  相似文献   

15.
The aim of this investigation was to study the possible relationships between anthropometry, flexibility and specific swimming results in female breaststroke swimmers. Subjects were 125 female breaststroke swimmers in age of 11-18 years. Body height and mass were measured and BMI (kg/m2 ) and Broca index (body height in cm - 100 = weight in kg) were calculated. The flexibility of hip external rotation, knee external rotation, ankle dorsal flexion and ankle supination were measured with plastic goniometer. 100 m breaststroke swimming using kickboard and legs only was used as a swimming performance parameter. The number of kicks was also fixed. Horizontal jumping ability was measured using a simple standing broad jump (cm) minus body height (cm). As a rule, flexibility in different joints did not depend on anthropometrical parameters. Only knee external rotation and ankle dorsal flexion correlated significantly with body mass (r = -0.221 and r = -0.210, respectively) and BMI (r = 0.242 and r = 0.204, respectively). The relationship between flexibility in different joints, as a rule, was not significant. Stepwise multiple regression analysis indicated that from the used anthropometrical parameters the most important was the body height, which explained 11.1% (R2 x 100) of the 100 m breaststroke swim results using legs only. The most important parameter from the measured flexibility indices was knee external rotation (11.1%, R2 x 100). Combination of knee external rotation and ankle supination increased the determination coefficient to 24.4%. Finally, three flexibility measures (knee external rotation, ankle supination, hip external rotation) explained the swimming results by 28.2% (R2 x 100). It was concluded that the good flexibility is more important than single anthropometrical parameters when explaining the breaststroke swimming results using kickboard and legs only.  相似文献   

16.
Objective: Postprandial glucagon‐like peptide 1 (GLP‐1) release seems to be attenuated in obese subjects. Results on whether weight loss improves GLP‐1 release are contradictory. The aim of this study was to further investigate the effect of weight loss on basal and postprandial GLP‐1 release in overweight/obese subjects. Research Methods and Procedures: Thirty‐two overweight/obese subjects participated in a repeated measurement design before (BMI, 30.3 ± 2.8 kg/m2; waist circumference, 92.6 ± 7.8 cm; hip circumference, 111.1 ± 7.4 cm) and after a weight loss period of 6 weeks (BMI, 28.2 ± 2.7 kg/m2; waist circumference, 85.5 ± 8.5 cm; hip circumference, 102.1 ± 9.2 cm). During weight loss, subjects received a very‐low‐calorie diet (Optifast) to replace three meals per day. Subjects came to the laboratory fasted, and after a baseline blood sample, received a standard breakfast (1.9 MJ). Postprandially, blood samples were taken every one‐half hour relative to intake for 120 minutes to determine GLP‐1, insulin, glucose, and free fatty acids from plasma. Appetite ratings were obtained with visual analog scales. Results: After weight loss, postprandial GLP‐1 concentrations at 30 and 60 minutes were significantly lower than before weight loss (p < 0.05). Glucose concentrations were also lower, and free fatty acids were higher compared with before weight loss. Ratings of satiety were increased, and hunger scores were decreased after weight loss (p < 0.05). Discussion: In overweight/obese subjects, GLP‐1 concentrations after weight loss were decreased compared with before weight loss, and nutrient‐related stimulation was abolished. This might be a response to a proceeding negative energy balance. Satiety and GLP‐1 seem to be unrelated in the long term.  相似文献   

17.
Objective: To examine the association between BMI (kilograms per meter squared) and reports of significant knee, hip, and back pain using data from a nationally representative sample of U.S. adults 60 years or older. Research Methods and Procedures: Population‐based survey data from the Third National Health and Nutrition Examination Survey, involving 5724 adults 60 years or older, were used. BMI, calculated from measured weight (kilograms) and height (meters squared), was used to categorize participants into six BMI‐defined groups: underweight (<18.5), desirable weight (18.5 to 24.9), overweight (25 to 29.9), obese class I (30 to 34.9), obese class II (35 to 39.9), and obese class III (≥40). The presence of significant knee, hip, and back pain in the groups was studied. Results: The overall prevalences of knee, hip, and back pain were 21%, 14%, and 22%, respectively. Prevalence estimates for knee (underweight 12.1% to obesity class III 55.7%), hip (underweight 10.4% to obesity class III 23.3%), and back (underweight 20.2% to obesity class III 26.1%) pain increased with increased BMI. Sex‐, race‐, and age‐specific pain prevalence estimates also generally increased at increased levels of BMI. Discussion: Among U.S. adults 60 years or older, the prevalence of significant knee, hip, and back pain increases with increased levels of BMI.  相似文献   

18.
The association between body mass index (BMI) categories and mortality remains uncertain. Using three National Health and Nutrition Examination Surveys covering the 1971–2006 period for cohorts born between 1896 and 1968, this study estimates separately for men and women models for year-of-birth (cohort) and year-of-observation (period) trends in how age-specific mortality rates differ across BMI categories. Among women, relative to the normal weight (BMI 18.5–24.9 kg/m2), there are increasing trends in mortality rates for the overweight (BMI 25–29.9) or obese (BMI ≥ 30). Among men, mortality rates relative to the normal weight decrease for the overweight, do not change for the moderately obese (BMI 30–34.9), and increase for the severely obese (BMI ≥ 35). Period and cohort trends are similar, but the cohort trends are more consistent. In the latest cohorts, compared with the normal weight, mortality rates are 50 percent lower for overweight men, not different for moderately obese men, and 100–200 percent higher for severely obese men and for overweight or obese women. For U.S. cohorts born after the 1920s, a lower overweight than normal weight mortality is confined to men. I speculate on possible reasons why the mortality association with overweight and obesity varies by sex and cohort.  相似文献   

19.
Based on the data of 203 male and 179 female schoolchildren from Eastern Austria (Burgenland), aged between 6 and 10 years, sex typical differences in body composition (absolute and relative body fat, lean body mass) and weight status were analyzed. Body composition analyses were carried out by means of BIA method, weight status was estimated using BMI percentiles (BMI > 90th percentile defined overweight, BMI > 97th percentile defined obesity). Statistically significant sex differences were found for all body composition parameters, girls exhibited a significantly higher amount of absolute and relative body fat, whereas their male counterparts exhibited a significantly higher amount of lean body mass. Regarding weight status, no statistically significant sex differences were observable, however, a higher amount of girls could be classified as overweight or obese. Evolutionary and sociocultural explanations for these observations are discussed.  相似文献   

20.
The purpose of the study is to develop current reference growth centiles for Turkish children and adolescents. A cross-sectional growth survey was conducted on 1.427 (709 boys and 718 girls) healthy schoolchildren aged 6-17 years in Ankara, the capital city of Turkey. As an indicator of socio-economic status, the occupation of the parents was recorded. Growth references of height, weight, body mass index (BMI), sitting height, iliospinal height, relative iliospinal height and relative sitting height were constructed by the LMS method. Sex differences, association of parental occupation with height and BMI standard deviation scores were assessed by analyses of variance. Results showed significant sexual dimorphism for height, weight, sitting height and iliospinal height (p<0.001). Significant effect of socio-economic background was found on height and BMI. The prevalence of overweight and obesity was found using the International Obesity Task Force (IOTF) reference criteria 22.4% and 5.6% in boys and 21.2% and 3% in girls. Present results demonstrated an increment during the last three decades in height, leg length and weight curves which is more prominent in boys, but not in the sitting height. This positive secular change appears to be a logical outcome of the gradual changes in nutrition, health care and education, and environmental and economic conditions.  相似文献   

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