Altitude and growth: a study of the patterns of physical growth of a high altitude Peruvian Quechua population

Data on physical growth were obtained for a sample of 1202 Quechua subjects, aged 2 to 35 years from the district of Nuñoa, Puno, located in the southern highlands (altitude 4000–5500m) of Peru. These data were supplemented by a three-year longitudinal study of 300 subjects, aged 1 to 22 years. The patterns of physical growth of members of the indigenous population of Nuñoa are characterized by (1) late sexual dimorphism, (2) slow and prolonged growth in body size, (3) late and poorly defined adolescent stature spurt in both males and females, and (4) accelerated development in chest size. The socio-economic factors associated with urban-rural and altitude differences appear to be reflected in greater deposition of subcutaneous fat and increased weight but do not seem to influence the development of stature. We suggest the pattern of growth of this population is related to the hypoxic effects of high altitude, and/or reflects a genetic adaptation to such stress. The anthropometric and physiological studies conducted during this and previous studies and the comparative data from Peruvian populations situated at lower altitudes document the specific adaptive response of the chest wall to the hypoxic effects of high altitude.     

Differences in physical growth of Aymara and Quechua children living at high altitude in Peru

Physical growth of Amerindian children living in two Aymara and three Quechua peasant communities in the Andean highlands of southern Peru (altitude 3,810–3,840 m) was studied, taking into account differences in the microclimate, agronomic situation, and sociodemographic variables. Anthropometric measurements were taken in 395 children aged under 14 years of age in a sample of 151 families in these communities, who were surveyed for sociodemographic variables as well. Data on the land system were available for 77 families. In comparison with reference populations from the United States (NCHS) and The Netherlands, stature, weight, head circumference, and midupper arm circumference (but not weight for stature) in the sample children were reduced. Growth retardation increased after the age of 1 year. Stature and weight in the present sample were very similar compared with previously published data on growth of rural Aymara children living near Lake Titicaca in Bolivia. Head circumference, midupper arm circumference, and weight for stature were significantly larger in Aymara children compared with Quechua children. Land was significantly more fragmented in Aymara compared with Quechua families, but amount of land owned was not different. Perinatal and infant mortality was elevated in Aymara vs. Quechua communities. Most families in Aymara communities used protected drinking water. One Quechua community had a severe microclimate, grim economic outlook, and weak social cohesion. Children in this community showed significant reductions in weight and midupper arm circumference compared with their peers in the other communities. We conclude that (presumably nutritionally mediated) intervillage and Aymara-Quechua differences in childhood physical growth existed in this rural high-altitude population in Peru and were associated with microclimate and the village economy, sociodemographic factors, and differences in the land system. © 1993 Wiley-Liss, Inc.     

β-fibrinogen allele frequencies in Peruvian Quechua,a high-altitude native population

Elevated hematocrits, which are found in many high-altitude populations, increase the oxygen-carrying capacity of blood and may represent an adaptation to hypoxic environments. However, as high hematocrit increases blood viscosity, which in turn is associated with hypertension and heart disease, it may be advantageous for high-altitude populations to limit other factors that contribute to increased blood viscosity. One such factor is the plasma concentration of the coagulation protein fibrinogen. Several common polymorphisms in the β-fibrinogen gene have been identified that affect fibrinogen concentrations. We determined the allele frequencies of three of these polymorphisms (G/A^-455(HaeIII), C/T^-148(HindIII), and G/A⁺⁴⁴⁸(MnlI)) in sample groups drawn from three populations: Quechua-speaking natives living at over 3,200 m in the Peruvian Andes, North American natives (Na-Dene) from coastal British Columbia, and Caucasian North Americans. The frequencies of the alleles previously shown to be associated with increased fibrinogen levels were so low in the Quechuas that their presence could be accounted for solely by genetic admixture with Caucasians. Frequencies in the Na-Dene, a Native American group unrelated to the Quechua, were not significantly different from those in Caucasians. Am J Phys Anthropol 109:181–186, 1999. © 1999 Wiley-Liss, Inc.     

Lung function and breathing pattern in subjects developing high altitude pulmonary edema

Introduction

The purpose of the study was to comprehensively evaluate physiologic changes associated with development of high altitude pulmonary edema (HAPE). We tested whether changes in pulmonary function and breathing pattern would herald clinically overt HAPE at an early stage.

Methods

In 18 mountaineers, spirometry, diffusing capacity, nitrogen washout, nocturnal ventilation and pulse oximetry were recorded at 490 m and during 3 days after rapid ascent to 4559 m. Findings were compared among subjects developing HAPE and those remaining well (controls).

Results

In 8 subjects subsequently developing radiographically documented HAPE at 4559 m, median FVC declined to 82% of low altitude baseline while closing volume increased to 164% of baseline (P<0.05, both instances). In 10 controls, FVC decreased slightly (to 93% baseline, P<0.05) but significantly less than in subjects with HAPE and closing volume remained unchanged. Sniff nasal pressure was reduced in both subjects with and without subsequent HAPE. During nights at 4559 m, mean nocturnal oxygen saturation dropped to lower values while minute ventilation, the number of periodic breathing cycles and heart rate were higher (60%; 8.6 L/min; 97 cycles/h; 94 beats/min, respectively) in subjects subsequently developing HAPE than in controls (73%; 5.1 L/min; 48 cycles/h; 79 beats/min; P<0.05 vs. HAPE, all instances).

Conclusion

The results comprehensively represent the pattern of physiologic alterations that precede overt HAPE. The changes in lung function are consistent with reduced lung compliance and impaired gas exchange. Pronounced nocturnal hypoxemia, ventilatory control instability and sympathetic stimulation are further signs of subsequent overt HAPE.

Registration

ClinicalTrials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT00274430","term_id":"NCT00274430"}}NCT00274430     

Hemoglobin levels in a Himalayan high altitude population

This report presents data on hemoglobin concentrations in a sample of Himalayan high altitude natives measured at their habitual altitude of residence. In this sample of 270 healthy Tibetan adults resident at 3250–3560 m in Upper Chumik, Nepal, the mean hemoglobin concentration is 16.1 ± 1.2 gm/dl among adult males, 14.4 ± 1.4 gm/dl among premenopausal and 15.0 ± 1.1 gm/dl among postmenopausal adult females. 123 of 126 (98%) males, 96 of 100 (96%) premenopausal and 36 of 44 (82%) postmenopausal females have hemoglobin concentrations within two standard deviations of the sea level mean. These data demonstrate that a healthy population may reside at high altitude without the degree of elevation in hemoglobin widely known and cited for Andean highlanders. Comparing published data on mean hemoglobin concentrations of adult Himalayan and Andean samples residing between 3200 m and 4100 m reveals that Himalayan means are systematically lower. This in turn may account for the reported population differences in the prevalence of chronic mountain sickness (Monge's disease). It is hypothesized that Himalayan and Andean highlanders represent alternative patterns of high altitude hematological adaptation.     

Platelet count and function at high altitude and in high-altitude pulmonary edema.

Platelet aggregation is the key process in primary hemostasis. Certain conditions such as hypoxia may induce platelet aggregation and lead to platelet sequestration primarily in the pulmonary microcirculation. We investigated the influence of high-altitude exposure on platelet function as part of a larger study on 30 subjects with a history of high-altitude pulmonary edema (HAPE) and 10 healthy controls. All participants were studied in the evening and the next morning at low altitude (450 m) and after an ascent to high altitude (4,559 m). Platelet count, platelet aggregation (platelet function analyzer PFA100; using epinephrine and ADP as activators), plasma soluble P (sP)-selectin, and the coagulation parameters prothrombin fragments 1+2 and thrombin-antithrombin complex were measured. High-altitude exposure decreased the platelet count, shortened the platelet function analyzer closure time by approximately 20%, indicating increased platelet aggregation, increased sP-selectin levels to approximately 250%, but left plasma coagulation unaffected. The HAPE-susceptible subjects were prophylactically treated with either tadalafil (a phosphodiesterase 5 inhibitor), dexamethasone, or placebo in a double-blind way. Subgroup analyses between these different treatments and comparisons of the seven placebo-treated individuals developing HAPE and controls revealed no differences in platelet count, platelet aggregation, or sP-selectin values. We conclude that exposure to high altitude activates platelets, which leads to platelet aggregation, platelet consumption, and decreased platelet count. These effects are, however, not more pronounced in individuals with a history of HAPE or actually suffering from HAPE than in controls and therefore may not be a pathophysiological mechanism of HAPE.     

Aerobic capacity of Peruvian Quechua: A test of the developmental adaptation hypothesis

High altitude natives are reported to have outstanding work capacity in spite of the challenge of oxygen transport and delivery in hypoxia. To evaluate the developmental effect of lifelong exposure to hypoxia on aerobic capacity, VO_2peak was measured on two groups of Peruvian Quechua subjects (18–35 years), who differed in their developmental exposure to altitude. Male and female volunteers were recruited in Lima, Peru (150 m), and were divided in two groups, based on their developmental exposure to hypoxia, those: a) Born at sea‐level individuals (BSL), with no developmental exposure to hypoxia (n = 34) and b) Born at high‐altitude individuals (BHA) with full developmental exposure to hypoxia (n = 32), but who migrated to sea‐level as adults (>16‐years‐old). Tests were conducted both in normoxia (BP = 750 mm Hg) and normobaric hypoxia at sea‐level (BP = 750 mm Hg, FiO₂ = 0.12, equivalent to 4,449 m), after a 2‐month training period (in order to control for initial differences in physical fitness) at sea‐level. BHA had a significantly higher VO_2peak at hypoxia (40.31 ± 1.0 ml/min/kg) as compared to BSL (35.78 ± 0.96 ml/min/kg, P = 0.001), adjusting for sex. The decrease of VO_2peak at HA relative to SL (ΔVO_2peak) was not different between groups, controlling for baseline levels (VO_2peak at sea‐level) and sex (BHA = 0.35 ± 0.04 l/min, BSL = 0.44 ± 0.04 l/min; P = 0.12). Forced vital capacity (controlling for height) and the residuals of VO_2peak (controlling for weight) had a significant association in the BHA group only (r = 0.155; P = 0.031). In sum, results indicate that developmental exposure to altitude constitutes an important factor to determine superior exercise performance. Am J Phys Anthropol 156:363–373, 2015. © 2014 Wiley Periodicals, Inc.     

模拟高原环境下高原肺水肿大鼠模型的建立

目的在人工实验舱模拟高原环境下,探讨建立高原肺水肿大鼠模型的条件。方法 Wistar大鼠,雌雄各半,随机分为5组:空白对照组、低氧24 h组、低氧48 h组、低氧72 h组、低氧7 d组,测定大鼠肺组织含水量,肺组织中TNF-α、IL-6含量及病理改变。结果与正常对照组相比,低氧24、48、72 h组大鼠肺组织含水量依次为(81.58±0.86)%、(82.13±0.57)%、(82.21±0.88)%,高于正常对照组(78.72±0.52)%,肺组织中IL-6依次为(329.30±133.58)、(323.92±127.42)、(506.29±197.19)pg/mL,TNF-α依次(221.08±20.26)、(208.05±20.33)、(244.63±51.53)pg/mL,高于正常对照组IL-6(187.26±69.49)pg/mL,TNF-α为(91.81±22.24)pg/mL。低氧7d组肺组织含水量(81.47±0.65)%、肺组织中IL-6(241.33±83.60)pg/mL、TNF-α(109.99±31.98)pg/mL,均显著低于低氧72h组,病理学结果显示72h组肺组织有炎性细胞浸润,肺泡壁有明显的充血和水肿。结论模拟海拔5000 m环境,建立大鼠肺水肿模型的较好的时间为72 h。     

高原鼠兔肺动脉血管功能及形态变化

目的研究肺循环对慢性缺氧的适应机理.方法在4300m的高度捕捉到高原适应动物鼠兔,带到2260m的高度并和10只Wistar大鼠在模拟4300m和5000m高度的低压仓内进行了肺动脉压的测定,观察肺组织学和组织免疫化学的改变.结果在2260m,鼠兔的Ppa明显低于Wistar大鼠,二者分别为(1.5±0@07)kPa和(2.9±1.1)kPa(P＜0.01).随着海拔高度的增加,鼠兔的Ppa上升不明显,而Wistar大鼠增加显著.左右心室比重鼠兔为0.22,而Wistar大鼠为0.45.鼠兔的Hb,Hct和2.3-DPG均低于大鼠.大鼠肺小血管周围可见肥大细胞(7.1±0.33)mm2,免疫组化染色mastcelltyptase颗粒呈阳性,鼠兔未发现肥大细胞及此种免疫反应.肺小动脉中层较鼠兔厚,分别为27.21%和9.22%,壁的厚度和Ppa有很好的(r=0.763).结论鼠兔无低氧性肺血管收缩,是一种遗传性适应.大鼠肥大细胞通过激活某些生长因子,在肺血管的再建过程中可能起一定作用.     

Influence of maternal nutritional status on prenatal growth in a Peruvian urban population

Anthropometric measurements were made on 4,952 mothers and their neonates from a Peruvian urban population. Based on age-specific percentiles, the mothers were separated into categories of short and tall stature, high and low fat, and high and low muscle. The study indicates that: (1) tall and short mothers characterized by similar subcutaneous fat and upper arm muscle area (whether high or low) had newborns with similar birth weight and recumbent length; (2) mothers characterized by high subcutaneous fat had heavier and fatter, but not longer, newborns than mothers with low subcutaneous fat; (3) mothers characterized by high upper arm muscle area had heavier, leaner and longer newborns than mothers with low upper arm muscle area; (4) mothers characterized by high muscle and high fat had heavier and longer newborns than mothers with high muscle and low fat; but (5) mothers characterized by high muscle and low fat had heavier and longer newborns than mothers with low muscle and high fat. Considering that subcutaneous fat and arm muscle area reflect calorie and protein reserves respectively, it is concluded that an increase in maternal calorie reserves results in increased infant fatness, but a lesser increase in linear growth. In contrast, an increase in maternal protein reserves does enhance both birth weight and prenatal linear growth.     

高原肺水肿易感基因多态性的全基因组关联分析

目的：高原肺水肿严重影响高原人群的健康。筛选高原肺水肿易感基因以用于高原肺水肿易感者的评估及防护。方法：利用Affymetrix SNP Array6．0芯片对23例高原肺水肿患者和17个健康对照进行全基因组SNP分型,利用PLINK软件进行了全基因组关联分析,利用Go和Pathway软件进行分析及作图。结果：全基因组关联分析获得39个相对显著的SNPs位点（P〈10^-4）。通过对这些SNP位点附近27个基因的c0和Pathway富集分析,发现这些基因主要参与细胞增殖调控过程、氮代谢过程和G蛋白耦联受体蛋白信号转导通路等。结论：本文发现的多态性位点及相关基因可能与高原肺水肿易感性相关。