Reference values for height, weight and body mass index of German born Turkish children

Turkish children and adolescents born in Northern Europe grow different from native Northern European children, but reference values for height, weight and BMI for these children do not exist. With this study, we intend to provide growth standards for German born Turkish children. Data were obtained from 797 Turkish children and adolescents born in Germany age 0-25.8 years (males), respectively 0-18.3 years (females). We generated synthetic reference values for height, weight, and BMI. The results show that Turkish children and adolescents are heavier after the age of 6 years, and that they remain short after puberty. Eighteen year old Turkish men, and 15-year-old Turkish women are shorter (males 175.2 cm vs. 180.4 cm, p < 0.05; females 159.3 cm vs. 165.0 cm, p < 0.05), and heavier than Germans. Six out of 53 young Turkish men and 9 out of 100 young Turkish women were obese. Twelve out of 53 young Turkish men (23%) and 18 out of 100 young Turkish women (18%) have fallen below the 3rd centile for height. It can be concluded that growth of Turkish children and adolescents born in Germany significantly differs from native children. Reference LMS values for body height, weight and BMI of German born Turkish boys and girls are presented.     

Estimation stature from X-rays of metacarpals in the Turkish population

Determination of stature is as important as the determination of sex and age when analyzing and identifying the remains of skeletons. Stature, in an approximate and widespread manner, is determined by the femur and tibia, i.e. those long bones that affect stature directly. However, when long bones are not available or when they are found in a very badly preserved condition that does not permit any estimation on stature, then other bones of the body can also be used for this purpose. The aim of this study is to determine stature with the help of metacarpals in the Turkish population. In this study, by using the X-ray films of metacarpal bones of 100 females and 100 males, regression equations have been set up for 5 metacarpal bones. The coefficients of correlation existing between the metacarpal bones and stature, together with the standard errors of these equations, have been intensively examined in this study. The results of studies conducted by other researchers such as Musgrave & Harneja (1978) and Meadows & Jantz (1992) have been compared with the results of our study. As a result of this comparison, the difference existing between them has been found to be significant according to the results of the t-test (p < 0.05, p < 0.01 and p < 0.001). The significance of such results proves that the general body characteristics and body proportions of populations are differing from each other and therefore specific regression equations for the different populations have to be set up.     

The short die young: the interrelationship between stature and longevity-evidence from skeletal remains

It has long been observed that tall people display longer life spans. The current data were employed to verify this association within the bioarchaeological context. To this end, stature and its association with age-at-death were analyzed in a pooled sample of 2,923 skeletons. Height was estimated from proxy indicators based on the maximum length of the humerus, radius, femur, and tibia. Stature estimation followed the procedure outlined by Pearson ([1899] Philos. Trans. R. Soc. Lond. [A] 192:169-244), incorporating minor modifications by R?sing ([ 1988] Handbuch der vergleichenden Biologie des Menschen; Stuttgart: Gustave Fischer, p 586-600). Individual age estimates were classified into three mutually exclusive age groups: 20-39 years (591 males, 667 females), 40-59 years (876 males, 499 females), and 60+ years (171 males, 119 females). The results document that both sexes display a statistically significant inverse relationship between adult height and age-at-death (males, P < 0.01; females, P < 0.05). Taking an epidemiological approach, the risk model implies that the estimated odds of survival beyond age 40 improve by approximately 16% for 1 SD in bone length. However, not all bones may be equally adept at displaying the association. The radius failed to support the positive association between stature and longevity, which may be indicative of a relatively greater contribution of environmental factor to radius length. Overall, the relationship between body height and longevity is not causal but coincidental: mitigated by diverse environmental factors such as nutrition, socioeconomic stressors, and disease load.     

An anatomical model to determine step height in step testing for estimating aerobic capacity

Physical fitness has been reported to be inversely related to coronary heart disease and other health related problems. One of the most valid means of assessing physical fitness is the test of aerobic capacity. Aerobic capacity is the greatest rate at which the body can consume oxygen and represents the most efficient integration of the various physiological processes which make up the oxygen transport system. However, direct measurement of aerobic capacity requires sophisticated laboratory equipment, and is adversive to subjects. Step tests are widely used to estimate aerobic capacity. Because the biomechanical efficiency and work rate is determined by step height, accommodation of step height to the subject's statute height should provide a better estimation of aerobic capacity. A hip angle of 73.3 degrees, when stepping, was found to give the best relationship of recovery heart rate of a step test to direct measurement of aerobic capacity. Using 73.3 degrees, the following equations were developed for determining the stepping height when using the step test: Hf = 0.189 Ih and Hf = 0.192 Ih for females and males respectively, where hf is the step height and Ih is the statute height of the subject. A correlation coefficient (r) of 0.93 was calculated between various hip angles and calculated foot height of 182 observations of 47 females while a correlation coefficient (r) of 0.96 was calculated from 208 observations of 53 males. Using these equations to determine step height, measurement of 30 females showed a mean hip angle of 73.3 degrees +/- 2.2 and measurement of 30 males showed a mean hip angle of 73.3 degrees +/- 2.1.(ABSTRACT TRUNCATED AT 250 WORDS)     

Determination of body surface area and formulas to estimate body surface area using the alginate method

The purpose of this study was to determine the body surface area (BSA) based on the alginate method, to derive formulae for estimating BSA, and to compare the error of the present formula to previous formulas obtained from other countries. We directly measured the entire body surface area of 34 males (20-60 years old, 158.5-187.5 cm in height, 48.5-103.1 kg in body weight) and 31 females (20-63 years old, 140.6-173.1 cm, 36.8-106.1 kg) using alginate. The measurements showed that the BSA had a mean of 18,339 cm(2) (15,416-22,753 cm(2)) for males, and 16,452 cm(2) (12,825-22,025 cm(2)) for females. Based on these measurements, a regression model to estimate BSA was derived: Estimated BSA (cm(2))=73.31 Height (cm)(0.725) x Weight (kg)(0.425) (r(2)=0.999). The mean error of the formula was -0.1%, and did not show any significant difference by gender or body shape. When applied to the datasets (n=506) composed of various races (Caucasians, Africans, and Asians), the mean error of the formula was 0.4% and was smaller than that of DuBois & DuBois's, Gehan & George's, and Mosteller's formulas when applied to the same datasets. The errors of the three previous formulas were also within 2%. Overall, formulas based on the DuBois exponent (Weight(0.425) Height (0.725)) did not show any tendency of overestimation or underestimation by body shape, but other BSA-formulae showed differences by body shape. The present BSA formula has shown good accuracy in Korean adults of all weight categories compared to traditional formulas.     

Body mass reconstruction on the basis of selected skeletal traits

The objective of this paper is: to estimate the body mass of the skeletons with the mechanical method (femoral head body mass estimation method--FH) and non-mechanical method (stature/living bi-iliac breadth body mass estimation method--ST/LBIB); to compare the reliability and potential use of results obtained with both methods. The material (46 skeletons, 26 males, 20 females) used in the study came from the medieval burial ground in Cedynia, Poland. Body mass reconstruction according to non-mechanical method was made using equations proposed by Ruff et al. (2005). Body mass estimation based on the mechanical method was calculated using formulas proposed by Ruff et al. (1995). In the mechanical body mass reconstruction method, femoral superoinferior breadth was used. Reconstruction of body weight using the non-mechanical method was based on maximum pelvic breadth and reconstructed body height. The correlation between bi-iliac breadth and femoral head measurements and the correlation between femoral head and reconstructed body height were also calculated. The significance of differences between the body mass of male and female individuals was tested with the Mann-Whitney U-test. The significance of differences between body mass values obtained with the mechanical (FH) and the non-mechanical method (ST/ LBIB) was tested using Pearson's correlation. The same test was used for the calculation of the relationship between bi-iliac breadth and femoral head measurements and between femoral head and reconstructed body height. In contrast to females, in males there is no statistically significant correlation between body mass estimated with the mechanical method (FH) and the non-mechanical method (ST/LBIB). In both sexes there was not statistically significant correlation between bi-iliac breadth and femoral head measurements. Only in the females group the correlation between femoral head and reconstructed body height was statistically significant. It is worth to continue the research. The obtained results would be a valuable contribution to the knowledge on body mass reconstruction methods.     

Blood pressure levels of the Suruí and Zoró Indians of the Brazilian Amazon: group- and sex-specific effects resulting from body composition, health status, and age

Two related Tupí-Mondê-speaking tribes of the Aripuan? Indian Park of western Brazil are compared in terms of their recent contact with Western culture, subsistence patterns, general health, and blood pressure levels. Age, weight, height, sex, and tribal affiliation for Suruí and Zoró adults over age 18 are included in an analysis of covariance to test regression models of both diastolic and systolic blood pressure. Because of significant interaction effects between sex and other covariates, sex-specific models were developed. The relationship between body mass and blood pressure level in males conforms with Western data, but the direction and magnitude of effects for the age and body mass covariates in both sexes conflict with data from other modernizing societies. With age, weight/height ratio, and sex differences controlled for, Suruí males show a lower mean systolic blood pressure (SBP) level and diastolic blood pressure (DBP) level than Zoró males. Intertribal differences were smaller among females: Suruí females SBP and DBP differences were similar but did not reach significance. Other sex-specific differences include a greater inverse relationship between age and SBP level among the 104 male subjects than among the 98 female subjects (with similar trends in DBP) and a small but significant effect of the weight/height ratio on both SBP and DBP in males but not in females. Health status data for these groups suggest that hypothesized increases in mean blood pressure levels following the Suruí's acceptance of a Western diet and social stratification may be modified by their health status, particularly prevalent infectious disease.     

Calcaneal measurement in estimation of stature of South African blacks

Stature (height) is an important factor in establishing the identity of a person in the living as well as in the skeletonized state. When stature is estimated from the bones of the limbs, regression equations, which estimate the ratios of the lengths of bones to the height of the individual, are generated. The majority of bones that were used previously were the long bones. The calcaneus was used for estimating stature only in American whites and blacks (Holland [1995] Am. J. Phys. Anthropol. 96:315-320). The regression equations that he generated were found to be useful for stature estimation in these population groups. Since the calcaneus has not been used for the same purpose in South Africa, the aim of this study was to derive regression equations that will allow this bone to be used for stature estimation in South African blacks. In total, 116 complete skeletons (60 males and 56 females) were selected from the Raymond A. Dart Collection of Human Skeletons, School of Anatomical Sciences, University of the Witwatersrand (Johannesburg, South Africa). The skeletal heights of these sets of skeletons were calculated using the anatomical method of Fully ([1956] Ann. Med. Leg. 35:266-273). Nine parameters of the calcaneus were measured and matched against skeletal heights, using univariate and multivariate regression methods. Regression equations were obtained for estimation of the stature of the South African black population from the calcaneus. The standard error of estimate that was obtained with univariate regression analysis was higher than the corresponding values using multivariate regression analysis. In both cases, the standard errors of estimate compared well with the values obtained for fragmentary long bones by previous authors.     

内蒙古兴安盟汉族体质调查

调查了内蒙古兴安盟乌兰浩特市320例城市汉族(男145人, 女175人)和突泉县太平乡514例乡村汉族(男256人, 女258人)的85项体质指标, 计算了32项指数及其分型。研究显示, 1)内蒙古兴安盟汉族的主要体质特征为:大多数人有上眼睑皱褶, 44.5%的人具蒙古褶,眼裂高度以窄、中型为主, 眼裂倾斜度以外高内低型最高; 鼻根高度以中、低型为主, 鼻基部多上翘或水平, 鼻梁侧面观多为直型, 鼻翼高度中等, 鼻孔最大径多横位或斜位; 上唇皮肤部高度多为中等型; 耳垂类型多为圆形、三角形; 黑发, 眼色褐色, 肤色黄或浅黄。男女均以特圆头型、高头型、中头型、狭鼻型、中面型、宽胸型、宽骨盆型、宽肩型及中肩型、长躯干型、亚短腿型居多。城市男女身高均以高型为主, 乡村男女身高中等或亚中等类型占优。2)兴安盟汉族城市人群的体质状况总体上优于乡村。3)兴安盟汉族的体质特征与蒙古族、回族、锡伯族等北方族群接近。     

Equation for estimating total body water by bioelectrical impedance measurements in Japanese subjects]

This article reports a study in which the equation for total body water (TBW) estimated from deuterium (2H2O)-dilution method and bioelectrical impedance measurement (BIM) is described. Subjects were 60 healthy males aged 30 +/- 18.3 yr (18-74) and 31 healthy females aged 37 +/- 17.5 yr (19-70). Total body water determined by the analysis of the dilution of orally ingested deuterium oxide (1g2H2O, 99.75 atom % excess/kg body weight) in urine. Bioelectrical impedance was measured for each subjects in a supine position using an electrical impedance analyzer (500 microA, 50kHz, T-1988K, Toyo Physical Inc.) with a four electrodes (Y-250, Nihon Kohden). The mean values of total body water and the impedance in males and females subjects were 34.1 +/- 4.27 l and 25.7 +/- 2.42 l, 567 +/- 28.5 omega and 562 +/- 32.5 omega, respectively. Height squared divided by resistance (Ht2/R) correlated well with TBW as measured by 2H2 O, r = 0.530 (p less than 0.001) in males and r = 0.782 (p less than 0.001) in females. The best-fitting regression equation to predict TBW comprised Ht2/R(X1) and body weight (X2) (R = 0.915, SEE = 1.70 l in males and R = 0.834, SEE = 1.28 l in females). Equations were provided with BIM instrument for the prediction of TBW: for males TBW, l = 0.1983X1 + 0.4004X2 - 0.7938 and for females TBW, l = 0.3536X1 + 0.1269X2 + 3.3417. These results suggest that bioelectrical impedance measurement is a useful measure of total body water in Japanese subjects.     

Vital capacity in trained and untrained healthy young adults in the Netherlands

Slow inspiratory vital capacity was measured in 226 healthy young adults, aged from 17 to 35 years. The group included 119 men and 107 women, 87 trained subjects, 71 untrained subjects who intended to take part in a training program for competitive rowing, and 68 untrained subjects who never took part in any competitive sport. The vital capacity increased with height, weight, fat-free mass, height X fat-free mass, and height-independent fat-free mass, with men having significantly higher vital capacities than women of the same height or weight. In both males and females vital capacity showed the best relation with height X fat-free mass (correlation coefficients are 0.78 and 0.57 respectively). Multiple regression on vital capacity with height, weight, fat-free mass, height X fat-free mass, height-independent fat-free mass, percentage body fat, and age increased the correlation coefficient only slightly (0.80 and 0.59 respectively). The subjects had vital capacities that were much higher than those predicted for them by equations originating from the USA. There was no difference between the observed vital capacities and those predicted by equations originating from Europe. There is a difference in vital capacity between the European subjects studied and subjects of similar height studied in the USA. This implies that equations derived from subjects in the USA cannot be applied to European subjects. From our results we conclude that vital capacity is not increased by physical activity.(ABSTRACT TRUNCATED AT 250 WORDS)     

Estimation of stature in children from second metacarpal measurements.

On the basis of 552 boys and 542 girls aged 6 to 20 years, this study examines the estimation of stature from dimensions and maturity of second metacarpals by means of linear regression equations. A combination of length and width measurements provided a more accurate estimation than each measurement individually. When taken alone, length produced a more accurate estimation than width. Sex and age factors are useful for the estimation of stature, though these variables are often unknown in the isolated bone. The samples are divided into immature and mature groups (according to skeletal maturity). Regardless of sex, stature could be estimated from the metacarpal length and width with a standard error of 4.19 cm by means of a multiple linear equation in the immature group. The mature group should be considered with adults for this purpose. Thus, taking into account their skeletal maturity, living stature could be practically estimated from the second metacarpal with significant degrees of accuracy in children.     

Histologic estimation of age at death using the anterior cortex of the femur

This report describes a new histologic method for determination of age at death, the latest in a series of studies that began with Kerley's pioneer presentation in 1965. The study population was collected from 328 documented individuals from an anatomy dissecting room in the United States, from two modern cemeteries in the Dominican Republic, and from autopsies performed in a Chilean hospital. Undecalcified thin sections 1.0 cm wide were made from specimens taken from the femoral midshaft directly opposite the linea aspera. Five 0.886 mm2 fields were located at the periosteal edge and photographed, mainly for purposes of defining the fields and providing a permanent record. Secondary osteons, type II osteons, osteon fragments, resorption spaces, and non-Haversian canals were recorded as number/mm2, and a 100-space grid was used to measure average percent of unremodeled, osteonal, and fragmental bone. Stepwise regression analysis of the measurements produced a series of regression equations for age estimation for females, males, and sexes combined. Most equations have a standard error of estimate of about 10 years, but the coefficients of determination (r2) range from 0.48 to 0.72. In practice, sex-specific equations gave better results than opposite-sex or nonspecific equations, mainly because males and females differed in the pattern of relations between osteons and osteon fragments with advancing age.     

Estimation of body fat in female rhesus monkeys

Measurement of height (crown–rump length), body weight, and abdominal subcutaneous fat depth, based on skinfold thickness taken from 13 female rhesus monkeys comprising two age groups were correlated with body fat values derived from tritiated water determinations of total body water. The manner with which each measure was related to percent body fat differed as a function of age of the animal. In the young, nulliparous females, crown–rump length was the single best predictor of body fat, whereas in the older, multiparous females, skinfold thickness correlated most highly with body fat. When all measurements, including the Quetelet index [(wt/ht)² × 1,000], were combined statistically and regressed against percent body fat, a significant increase in predictive ability was obtained. When each age group was considered separately, the resulting equations again reflected the agegroup biases. In addition, as an internal check on the validity of the regression equations, an additional regression analysis was performed using morphometric data from selected animals in each age group. These equations yielded accurate estimates of body fat when compared to determinations made from total body water. These analyses indicate that the predictive accuracy of morphometric data is greatly enhanced by using these measurements in concert. Furthermore, the utility of such predictions is influenced by the specific physical characteristics of the subject population.     

Technical note: Criterion validity of whole body surface area equations: a comparison using 3D laser scanning

Measurements of whole body surface area (WBSA) have important applications in numerous fields including biological anthropology, clinical medicine, biomechanics, and sports science. Currently, WBSA is most often estimated using predictive equations due to the complex and time consuming methods required for direct measurement. The main aim of this study was to identify whether there were significant and meaningful differences between WBSA measurements taken using a whole body three-dimensional (3D) scanner (criterion measure) and the estimates derived from each WBSA equation identified from a systematic review. The study also aimed to determine whether differences varied according to body mass index (BMI), sex, or athletic status. Fifteen WBSA equations were compared with direct measurements taken on 1,714 young adult subjects, aged 18-30 years, using the Vitus Smart 3D whole body scanner, including 1,452 subjects (753 males, 699 females) from the general Australian population and 262 rowers (148 males, 114 females). Mixed-design analysis of variances determined significant differences and accuracy was quantified using Bland-Altman analysis and effect sizes. Thirteen of the 15 equations overestimated WBSA. With a few exceptions, equations were accurate with a low-systematic error (bias ≤2%) and low-random error (standard deviation of the differences 1.5-3.0%). However, BMI did have a substantial impact with the accuracy of some WBSA equations varying between the four BMI categories. The Shuter and Aslani: Eur J Appl Physiol 82 (2000) 250-254 equation was identified as the most accurate equation and should be used for Western populations 18-30 years of age. Care must be taken when deciding which equation to use when estimating WBSA.     

Some aspects of aging in the lumbar spine

I measured the bodies of vertebrae L3 and L4 of 338 skeletons from the Terry collection in the Smithsonian Institution, including Blacks and Whites, males and females, aged from 20 to 90 years. Transverse breadths of the upper and lower endplates (excluding osteophytes) and minimum transverse breadths all increase with age. In general, the greater broadening occurs in the endplates, but the middle of the body also broadens to such a degree that there is no demonstrable increase in vertebral “flaring” with age. In males, posterior body height decreases relative to anterior height, so that the lumbar bodies become more wedge-shaped with age, but females show essentially no change. Anterior height decreases in proportion to minimum breadth, so that the lumbar bodies become relatively lower and broader, and this change is significantly correlated with age in all groups. Midbody height decreases relative to anterior height, so that Nordin's biconcavity index is reduced with age. The increase in biconcavity remains evident even when average anterior-posterior height is used to calculate the index. At all age levels a high percentage of individuals have biconcavity indices of 80% or less, indicating that Nordin's standard of normality for this index, established from measurement on radiographs of the living, should be revised downward for use in evaluating osteoporosis in skeletal populations.     

A revision of body surface area estimations

The results from the present study indicate that the equation of Dubois and Dubois (1916), now in common use for estimating body surface area, is not the most accurate of those available. Our new equation is based on the measurement of body weight and upper calf circumference only. It accounts for a large percentage of the total variance (88.9%), and has a low standard error of estimate (0.05 m2), which suggests that this equation may be more useful in the estimation of human body surface area than many of the equations previously produced. Direct comparisons of the accuracy of other workers' equations is difficult to assess due to the different methods by which the equations have been produced and expressed. We do not advocate the use of different equations for males and females because the data indicate that the present equation probably applies equally well to both sexes.     

Potassium per kilogram fat-free mass and total body potassium: predictions from sex,age, and anthropometry

Total body potassium (TBK) is located mainly intracellularly and constitutes an index of fat-free mass (FFM). The aim was to examine whether TBK and the TBK-to-FFM ratio (TBK/FFM) can be estimated from sex, age, weight, and height. A primary study group (164 males, 205 females) and a validation group (161 and 206), aged 37-61 yr, were randomly selected from the general population. TBK was determined by whole body counting, and FFM was obtained by dual-energy X-ray absorptiometry (DEXA; FFM(DEXA)). The primary study group was used to construct sex-specific equations predicting TBK and TBK/FFM from age, weight, and height. The equations were used to estimate TBK and TBK/FFM in the validation group. The estimates were compared with measured values. TBK in different age ranges was predicted, with errors ranging from 5.0 to 6.8%; errors for TBK/FFM ranged from 2.7 to 4.8%, respectively. By adding FFM(DEXA) as a fourth predictor, the error of the TBK prediction decreased by approximately two percentage units. In conclusion, TBK and TBK/FFM can be meaningfully estimated from sex, age, weight, and height.     

The muscle-bone unit in adulthood: influence of sex, height, age and gynecological history on the bone mineral content and muscle cross-sectional area

Bone and muscle development are both strongly influenced by sex hormones. The purpose of this study was to examine the changes in bone and muscle parameters (bone mineral content - BMC, muscle cross-sectional area - MA) in 130 men aged 31 -60 years, and in 180 pre-menopausal women aged 30-53 years with respect to age, body height and, with the women, their gynecological history (age-at-menarche, number of pregnancies, duration of lactation and use of oral contraception). The study was performed using peripheral quantitative computed tomography (pQCT) at a 65% site of the forearm length. Both BMC and MA were dependent on body height (p<0.0001), but not on age. The BMC/MA ratio was dependent neither on age nor on body height in both genders. MA as well as BMC were found significantly higher in males than in females (p<0.0001 for both variables). We observed a significantly higher BMC/MA ratio in females than in males (p<0.0001). We found no effect either of the analyzed variables of gynecological history on bone/muscle characteristics. The findings highlight the necessity of involving height-adjusted parameters and BMC/MA ratio into bone analysis in adults.     

Plasma lipids in Turkish children: impact of puberty, socioeconomic status, and nutrition on plasma cholesterol and HDL.

In Turkish adults, HDL cholesterol (HDL-C) levels are 10-15 mg/dl lower than those of adults in western Europe and the United States. In this study, we determined whether HDL-C levels in Turks are low from birth to adulthood and assessed the effect of socioeconomic status (SES) on plasma lipids and lipoproteins. Analyses of cord blood from 105 Turkish newborns showed low levels of plasma cholesterol ( approximately 60 mg/dl) and HDL-C (approximately 30 mg/dl), consistent with results from other Western ethnic groups. Prepubescent 8- to 10-year-old Turkish boys and girls of upper (n = 82) and lower (n = 143) SES had high HDL-C levels (50-60 mg/dl) similar to those of western European children. However, the cholesterol (154-158 mg/dl) and HDL-C (55-58 mg/dl) levels of upper SES children were approximately 25 and approximately 12 mg/dl higher, respectively, than those of lower SES children. Height, weight, skinfold thickness, and estimated body fat were greater in the upper SES children and appeared to reflect dietary differences. Upper SES children consumed more total fat (approximately 35% vs. 25% of total calories), including more saturated fat of animal origin, and less carbohydrate (approximately 50% vs. 62% of total calories), consistent with their elevated plasma cholesterol levels. Carbohydrate intake correlated inversely with the HDL-C level. The HDL-C levels in the prepubescent children, especially those of higher SES, who consumed diets more like western Europeans, decreased markedly to adult levels, with males exhibiting a approximately 20 mg/dl decrease (from 58 to 37 mg/dl) and females a approximately 13 mg/dl decrease (from 55 to 42 mg/dl). SES did not affect HDL-C levels in adults. The profound decrease may reflect alterations in androgen/estrogen balance in Turks at puberty and a modulation of hepatic lipase affecting HDL-C levels.