Ontogenetic development of children and adolescents from a care and educational centre in Bierutów preliminary study

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1 CHAPTER VI HEALTH AND WELLNESS 1/2014 WELLNESS AND TEAM 1 Department of Normal Anatomy, Wroclaw Medical University Katedra i Zakład Anatomii Prawidłowej Uniwersytetu Medycznego im. Piastów Śląskich we Wrocławiu 2 Department of Dental Anatomy, Wroclaw Medical University Zakład Anatomii Stomatologicznej Uniwersytetu Medycznego im. Piastów Śląskich we Wrocławiu 3 Department of Pathophysiology, Wroclaw Medical University Katedra i Zakład Patofizjologii Uniwersytetu Medycznego im. Piastów Śląskich we Wrocławiu 4 Nonpublic Medical College in Wrocław Niepubliczna Wyższa Szkoła Medyczna we Wrocławiu 5 Public Medical Training College in Opole Państwowa Medyczna Wyższa Szkoła Zawodowa w Opolu 6 Katedra Technologii Surowców Zwierzęcych i Zarządzania Jakością, Uniwersytet Przyrodniczy we Wrocławiu Department of Animal Products Technology and Quality Management, Wroclaw University of Environmental and Life Sciences MICHAŁ PORWOLIK 1,4, KRYSTIAN PORWOLIK 1,5, ZYGMUNT DOMAGAŁA 1, SŁAWOMIR WOŹNIAK 1, PAWEŁ DĄBROWSKI 1, ALEKSANDRA KOTYLAK 1, WIESŁAW KURLEJ 2, DARIUSZ KAŁKA 3, MACIEJ OZIEMBŁOWSKI 6, MIROSŁAW TRZASKA 1, KATARZYNA STASZAK 2, BOŻENA KURC-DARAK 2, JACEK ZBOROWSKI 2, BOHDAN GWORYS 1 Ontogenetic development of children and adolescents from a care and educational centre in Bierutów preliminary study Zaawansowanie w ontogenezie dzieci wychowywanych w placówce szkolno-wychowawczej w Bierutowie - badania wstępne Key words: ontogenesis in childhood, anthropometric studies in children and adolescents Słowa kluczowe: okres dziecięcy w ontogenezie, badania antropometryczne dzieci

2 66 HEALTH AND WELLNESS 1/2014 Wellness and team INTRODUCTION Normal somatic development during childhood has an impact on the health of adult humans. Therefore, periodic and check up examinations, as well as general preventive health-promoting measures play an important role in the assessment of ontogenesis [15]. For many centuries a temporal variability of standards for somatic growth has been observed in children and adolescents, leading to anatomical changes in adult humans. This dynamic process affecting differences in human biological traits between generations has been defined as a secular trend [26]. The first documented reports on human development and growth were published in 1753 by Roederen J. G., and in 1778 by Georges-Louis Leclerc Comte de Buffon. In Poland, the first reports related to this subject were published by F. Suligowski (1887) and W. Kosmowski (1887) [after 17]. The greatest contribution to the development and understanding of auxology in the post-war period was made by Wolański N., Malinowski A., Hulanicka B., and Jopkiewicz A. Human ontogenesis is determined by genetic (intrinsic) and environmental (extrinsic) factors [29]. The manifestation of genetic factors inherited from ancestors, i.e. phenotype, is strongly associated with multiple environmental determinants. The strong influence of various factors on the somatic traits was demonstrated by A. Malinowski [21], who analysed the values of body height, recorded between 1886 and He indicated that in Poland, over 113 years, the later generations were over 16 cm taller than those born in earlier years. The adverse effect on the body height of people living in earlier times is attributed to the frequent national independence uprisings and wars that took place in the past two centuries in Europe, which eliminated individuals with the best biological traits. Other important factors included the ubiquitous hunger at that time, the intake of monotonous food of low nutritional value, and the impoverishment of the society, leading to a dramatic deterioration in socio-economic conditions. Recent years have brought the elimination or reduction of negative factors, such as zoonoses, global wars, improper diet, nicotine addiction and alcoholism, and an improvement in hygiene and living standards, accelerating many positive biological traits. Puberty is observed at a younger age, life expectancy and professional activity are longer, and body proportions have changed. At this moment it is difficult to unequivocally assess the potential impact of new risk factors, such as global warming, climate change, environmental pollution, food additives, genetically modified food, a gradual decline in fertility, increase in the frequency of late motherhood, or the proclaimed end of the era of antibiotics and increased incidence of cancer. Many reports analysing the correlation between biological traits and a number of factors influencing them have been published, but this problem continues to be valid. The authors of this study carried out preventive and health-promoting measures in a group of children and adolescents from the care and educational centre in Bierutów, near Wrocław. The aim of the study was to evaluate selected anthropometric parameters in children and adolescents staying at the care and educational centre under specific conditions, and in many cases coming from poor families with many children, and facing difficult social and economic conditions. The influence of the mother, father and other relatives was eliminated during the educational, care and growth process-

3 Michał Porwolik, Krystian Porwolik, Zygmunt Domagała, Sławomir Woźniak, Paweł Dąbrowski, Aleksandra Kotylak, Wiesław Kurlej, Dariusz Kałka, Maciej Oziembłowski, Mirosław Trzaska, Katarzyna Staszak, Bożena Kurc-Darak, Jacek Zborowski, Bohdan Gworys Ontogenetic development of children and adolescents from a care and educational centre in Bierutów preliminary study es. This preliminary study is a starting point for further research, and in time will become a reference for future research. MATERIALS AND METHODS The preliminary anthropometric study was conducted in 27 children (13 girls and 14 boys) aged 8 to 18 years. Measurements were taken on at the care and educational centre in Bierutów. For each child or adolescent we recorded: age, body height (B-v) and body weight, trunk length (sst-sy), upper extremity length (BdaIII), lower extremity length (B-sy), biacromial diameter (a-a), bi-iliocristal diameter (ic-ic), chest diameter (tl-tl) and chest depth (xi-ts). We also measured the girth of chest, abdomen and hips, and the thickness of biceps, and subscapular and abdominal skinfolds. Anthropometric measurements were taken according to the technique by Martin and Saller [22]. The statistical analysis of the measured parameters was carried out using an Excel spreadsheet. Each value of the analysed traits was compared to body growth standards for the relevant age group of healthy children (centile chart). Obtained values were used to calculate three indices describing body length, body width and body fatness. The index of body length was the mean obtained for centiles of body height, trunk length and lower extremity length. The index of body width was the mean of biacromial, chest and bi-iliocristal diameters and chest depth. The mean calculated for chest girth, body weight and the three skinfolds (biceps, subscapular and abdominal) was the index of body fatness. Children were divided into three groups depending on the value of individual indices: 1) children with somatic growth described by high centile values; 2) children with somatic growth described by diversified centile values; 3) children with somatic growth described by low centile values. RESULTS Centile values for individual somatic parameters analysed separately for boys and girls, divided into three groups, are presented in tables 1, 2, 3, 4, 5 and 6. The summary of mean centile values for each of the three analysed indices in boys and girls, in the three groups, is presented in tables 7, 8, 9, 10, 11 and 12. The distribution of analysed traits is presented in a diagrammatic format separately for each studied boy and girl, in individual groups, in figures 1, 2, 3, 4, 5, 6. 67

4 HEALTH AND WELLNESS 1/2014 Wellness and team Table 1. Summary of somatic traits for the group of boys with high centile values Age Sex M M M M M no. of studied child B-v sst-sy B-sy a-a tl-tl xi-ts ic-ic Chest girth Body weight Biceps skinfold Subscapular skinfold Abdominal skinfold Table 2. Summary of somatic traits for the group of boys with diversified centile values Age Sex M M M no. of studied child B-v sst-sy B-sy a-a tl-tl xi-ts ic-ic Chest girth Body weight Biceps skinfold Subscapular skinfold Abdominal skinfold Table 3. Summary of somatic traits for the group of boys with low centile values Age Sex M M M M M M no. of studied child B-v sst-sy

5 Michał Porwolik, Krystian Porwolik, Zygmunt Domagała, Sławomir Woźniak, Paweł Dąbrowski, Aleksandra Kotylak, Wiesław Kurlej, Dariusz Kałka, Maciej Oziembłowski, Mirosław Trzaska, Katarzyna Staszak, Bożena Kurc-Darak, Jacek Zborowski, Bohdan Gworys Ontogenetic development of children and adolescents from a care and educational centre in Bierutów preliminary study Age Sex M M M M M M B-sy a-a tl-tl xi-ts ic-ic Chest girth Body weight Biceps skinfold Subscapular skinfold Abdominal skinfold Table 4. Summary of somatic traits for the group of girls with high centile values Age Sex F F F F F F no. of studied child B-v sst-sy B-sy a-a tl-tl xi-ts ic-ic Chest girth Body weight Biceps skinfold Subscapular skinfold Abdominal skinfold Table 5. Summary of somatic traits for the group of girls with diversified centile values Age Sex F F F F F no. of studied child B-v sst-sy B-sy a-a

6 HEALTH AND WELLNESS 1/2014 Wellness and team Age Sex F F F F F tl-tl xi-ts ic-ic Chest girth Body weight Biceps skinfold Subscapular skinfold Abdominal skinfold Table 6. Summary of somatic traits for the group of girls with low centile values Age Sex F F no. of studied child 3 7 B-v sst-sy B-sy 8 13 a-a 2 22 tl-tl 44 7 xi-ts ic-ic 4 50 Chest girth Body weight 6 8 Biceps skinfold Subscapular skinfold Abdominal skinfold Table 7. Parameters of analysed indices for the group of boys with high centile values Age Sex M M M M M no. of studied child Index of body length Index of body width Index of body fatness

7 Michał Porwolik, Krystian Porwolik, Zygmunt Domagała, Sławomir Woźniak, Paweł Dąbrowski, Aleksandra Kotylak, Wiesław Kurlej, Dariusz Kałka, Maciej Oziembłowski, Mirosław Trzaska, Katarzyna Staszak, Bożena Kurc-Darak, Jacek Zborowski, Bohdan Gworys Ontogenetic development of children and adolescents from a care and educational centre in Bierutów preliminary study Table 8. Parameters of analysed indices for the group of boys with diversified centile values Age Sex M M M no. of studied child Index of body length Index of body width Index of body fatness Table 9. Parameters of analysed indices for the group of boys with low centile values Age Sex M M M M M M no. of studied child Index of body length Index of body width Index of body fatness Table 10. Parameters of analysed indices for the group of girls with high centile values Age Sex F F F F F F no. of studied child Index of body length Index of body width Index of body fatness Table 11. Parameters of analysed indices for the group of girls with diversified centile values Age Sex F F F F F no. of studied child Index of body length Index of body width Index of body fatness

8 HEALTH AND WELLNESS 1/2014 Wellness and team Table 12. Parameters of analysed indices for the group of girls with low centile values Age Sex F F no. of studied child 3 7 Index of body length Index of body width Index of body fatness Centile No 2 No 17 No 25 No 29 No Indices Fig. 1. Distribution of analysed indices for the group of boys with high centile values 72

9 Michał Porwolik, Krystian Porwolik, Zygmunt Domagała, Sławomir Woźniak, Paweł Dąbrowski, Aleksandra Kotylak, Wiesław Kurlej, Dariusz Kałka, Maciej Oziembłowski, Mirosław Trzaska, Katarzyna Staszak, Bożena Kurc-Darak, Jacek Zborowski, Bohdan Gworys Ontogenetic development of children and adolescents from a care and educational centre in Bierutów preliminary study No 12 No 18 No Centile Indices Fig. 2. Distribution of analysed indices for the group of boys with diversified centile values No 13 No 14 No 16 No 21 No 26 No Centile Indices Fig. 3. Distribution of analysed indices for the group of boys with low centile values 73

10 HEALTH AND WELLNESS 1/2014 Wellness and team Centile No 5 No 8 No 10 No 11 No 19 No Indices Fig. 4. Distribution of analysed indices for the group of girls with high centile values No 6 No 15 No 20 No 23 No Centile Indices Fig. 5. Distribution of analysed indices for the group of girls with diversified centile values. 74

11 Michał Porwolik, Krystian Porwolik, Zygmunt Domagała, Sławomir Woźniak, Paweł Dąbrowski, Aleksandra Kotylak, Wiesław Kurlej, Dariusz Kałka, Maciej Oziembłowski, Mirosław Trzaska, Katarzyna Staszak, Bożena Kurc-Darak, Jacek Zborowski, Bohdan Gworys Ontogenetic development of children and adolescents from a care and educational centre in Bierutów preliminary study No 3 No 7 60 Centile Indices Fig. 6. Distribution of analysed indices for the group of girls with low centile values DISCUSSION It is now believed that the growth of healthy children in early childhood, i.e. from birth to age five years, whose basic biological needs are satisfied, are breastfed, and provided with proper health care and hygiene, is similar regardless of ethnic or socio-economic differences [9 after 30]. This view relies on the results from longterm cross-sectional studies on somatic growth initiated by WHO and carried out on all continents except for Australia. Since 2009 the use of centile charts recommended by WHO is also advised as a part of the standard approach to child growth assessment in Poland, because their comparison with Warsaw reference standards shows minor or no differences, making them useful for the assessment of somatic growth [25,14]. WHO data and analyses of numerous auxology reports indicated that body height and weight are good biological parameters responding to socioeconomic inequalities experienced after the fifth year of age in older age groups. These parameters are highly sensitive to changing environmental factors and are able to react to the slightest differences in living conditions. Authors of numerous studies pointed out the particularly strong influence of factors such as parents' educational level, number of children in the family, income level, birth order, place of residence, or housing conditions [31,13,10,24,16,21,8,23]. Higher rate of body growth is also associated with higher socio-economic status [3,11]. Some reports 75

12 HEALTH AND WELLNESS 1/2014 Wellness and team indicated the number of children in a family as the variable with the strongest modifying effect on body height in boys and girls aged 6 to 18 years [2,31,32,10,19,11]. There are also reports suggesting that parents' educational level is the strongest environmental factor determining growth [1,6,27,28]. As with body weight, and with body height, some reports indicate the impact of the number of children per family and parents educational level [31,13,7] or place of residence [23,8,16,20]. Other reports emphasize the fact that this trait is less susceptible to socio-economic factors than to genetic determinants [18,5], but it also correlates with lifestyle and physical activity [4]. The results of a further series of studies will show how strong the correlations are between somatic traits in the analysed children and environmental and genetic factors. A single study can only help to assess the child's somatic growth on the day of examination and indicate abnormalities in a certain age group. The results of these examinations will allow for predicting the growth rate of the analysed traits, identify the developmental trend in each of the examined children and the risk of growth abnormalities, and the efficiency of potential treatment. Findings from our preliminary study confirm the observations made by other researchers [1,23,10,12,] on the greater ecosensitivity of growth in boys, as well as on the correlation between poorer somatic growth and the number of children in a family [10,1], with the best growth parameters found in boys being the only child. The study demonstrated that there was a higher number of boys with low body growth parameters when compared to girls. Moreover, growth should be monitored in the group of boys and girls who had much higher values of the body fatness index when compared to the two other indices. CONCLUSIONS 1. Four children (two girls and two boys) were referred for further thorough medical examination due to the low values of the analysed traits. 2. The group of boys with low values of traits that require further monitoring is more numerous than the group of girls. 3. Four girls and three boys had low values of body length and width, but at the same time high values of body fatness. REFERENCES 1. Asienkiewicz R.: Rozwój populacji dzieci Zielonej Góry w świetle wybranych zmiennych społecznych. Prace Naukowe Akademii im Jana Długosza w Częstochowie, 2005, VI: Asienkiewicz R.: Stratyfikacja społeczna rodziców a poziom rozwoju fizycznego i motorycznego ich dzieci. Słupskie prace biologiczne, 2005, 1: Bielecki T.: Nierówności społeczne w oczach antropologa. Nauka Polska, 1989, 1:

13 Michał Porwolik, Krystian Porwolik, Zygmunt Domagała, Sławomir Woźniak, Paweł Dąbrowski, Aleksandra Kotylak, Wiesław Kurlej, Dariusz Kałka, Maciej Oziembłowski, Mirosław Trzaska, Katarzyna Staszak, Bożena Kurc-Darak, Jacek Zborowski, Bohdan Gworys Ontogenetic development of children and adolescents from a care and educational centre in Bierutów preliminary study 4. Bogin B., Sullivan T.: Socioeconomic status, sex, age, and ethnicity as determinants of body fat distribution for Guatemalan children. Am. J. Phys. Anthropol., 1986, 69: Bouchard C.: Genetic determinants of regional FAT distribution, Hum. Reprod., 1997, 12: Charzewski J., Piechaczek H.: Differences in the somatic development of Warsaw children in relation to Barents social status. Phys. Educ. Sport, 2001, 45, 4: Chrzanowska M.: Biologiczne i społeczno-ekonomiczne determinanty rozwoju podskórnej tkanki tłuszczowej u dzieci i młodzieży, AWF, Wydawnictwo Monografie, Kraków, 1992, Cymek J. et al.: Stan rozwoju biologicznego dzieci wiejskich z Kociewa na tle warunków społeczno-ekonomicznych. Prz. Nauk Kult. Fiz., 2003, 3-4: De Onis M. et al.: Standardy WHO rozwoju fizycznego dzieci w wieku 0-5 lat i możliwości ich wykorzystania w Polsce. Medycyna Wieku Rozwojowego, 2010, 14, 2: Dziewięcki Cz. et al.: Monitoring rozwoju biologicznego dzieci warszawskich, in: Auksologia a promocja zdrowia, Jopkiewicz A., Ed. Wyd. Kieleckie Towarzysto Naukowe, Kielce, 2000, 2: Hulanicka B.: Stan biologiczny populacji Polskiej. Punkt widzenia antropologa. In: Stan zdrowia Polaków eds. Zatoński W., Hulanicka B., Tyczyński J. Zakład Antropologii PAN, Wrocław, 1996, 15: Jedlińska W.: Wpływ niektórych czynników środowiska społecznego na wysokość ciała dzieci szkolnych w Polsce. Przegląd Antropologiczny, 1985, 51: Jobkiewicz A.: Różnice społeczne w wysokości i masie ciała dzieci i młodzieży szkolnej na kielecczyźnie, In: Auksologia a promocja zdrowia, Jopkiewicz A., Publ. Kieleckie Towarzystwo Naukowe, Kielce, 2000, 2: Komitet Rozwoju Człowieka Polskiej Akademii Nauk, Komitet Antropologii Polskiej Akademii Nauk, Zarząd Główny Polskiego Towarzystwa Antropologicznego, Instytut Matki i Dziecka oraz Instytut żywności i żywienia: Rekomendacje dotyczące wykorzystania w Polsce standardów WHO rozwoju fizycznego dzieci 0 5 lat. Pediatria po Dyplomie, 2010, 15, 3: Krawczyński M.: Metody oceny rozwoju fizycznego wykorzystywane w praktyce poradnianej. Przew Lek, 2001, 4:

14 HEALTH AND WELLNESS 1/2014 Wellness and team 16. Król H.: Różnice środowiskowe w rozwoju cech somatycznych u chłopców i dziewcząt w okresie dojrzewania, In: Nowak S. ed. Studia Medyczne Akademii Świętokrzyskiej, Publ. Akademii Świętokrzyskiej, Kielce, 2004, 2: Kułaga Z. et al.: Siatki centylowe wysokości, masy ciała i wskaźnika masy ciała dzieci i młodzieży w Polsce wyniki badania OLAF standardy medyczne. Pediatria, 2010, 7: Malina R. et al.: Fatness and fat patterning among athletes at the Montreal Olympic games, Med. Sci Sport Exerc., 1982, 14: Malinowski A. et al.: Rozwój biologiczny dzieci i młodzieży szkolnej Włocławka standardy, warunki bytowe i uwarunkowania środowiskowe. Acta Univerisitatis Lodziensis, Folia Antropologica, 1993, Malinowski A.: Porównanie rozwoju fizycznego młodzieży wsi wielkopolskiej i Poznania z 2000 r. in: Zagórski J. et al. eds. Uwarunkowania rozwoju dzieci i młodzieży wiejskiej, Monografie JMW, Lublin, 2004, Malinowski A.: Wzrost niedostosowań społecznych młodzieży w kontekście przemian międzypokoleniowych rozwoju biologicznego. Zeszyty Naukowe Wyższej Szkoły Pedagogiki i Administracji w Poznaniu, 2006, 2: Martin R., Saller K.: Lerbuch der Anthropologii. G. Fischer Verlag, Stuttgart, Nowak M.: Rozwój somatyczny chłopców i dziewcząt wiejskich w wieku 6 19 lat z województwa podkarpackiego na tle serii miejskiej. Publ. UR Przegląd Medyczny Uniwersytetu Rzeszowskiego i Narodowego Instytutu Leków w Warszawie, Rzeszów, 2012, 3: Nowicki G.: Rozwój fizyczny dzieci i młodzieży w rodzinach wiejskich. Monografia, Publ. KPSW, Bydgoszcz, Oblacińska A. et al.: Ocena rozwoju fizycznego dzieci i młodzieży. Część I niemowlęta i dzieci do 5 lat normy krajowe czy standardy WHO? Medycyna Wieku Rozwojowego, 2010, 14, 2: Radochańska A. et al.: Trend sekularny w rozwoju fizycznym dzieci z Rzeszowa w wieku 7 14 lat. Prz. Med. Uniw. Rzesz., 2005, 2: Roślak M.: Oddziaływanie wybranych czynników środowiskowych na rozwój fizyczny łodzian w wieku 7 19 lat, in: Auksologia a promocja zdrowia, Jopkiewicz A. Wydawnictwo Kieleckie Towarzystwo Naukowe, Kielce 2000, 2: Stolarczyk H.: Społeczne uwarunkowania rozwoju fizycznego dzieci i młodzieży szkolnej Łodzi. Wydawnictwo Uniwersytetu Łódzkiego,

15 Michał Porwolik, Krystian Porwolik, Zygmunt Domagała, Sławomir Woźniak, Paweł Dąbrowski, Aleksandra Kotylak, Wiesław Kurlej, Dariusz Kałka, Maciej Oziembłowski, Mirosław Trzaska, Katarzyna Staszak, Bożena Kurc-Darak, Jacek Zborowski, Bohdan Gworys Ontogenetic development of children and adolescents from a care and educational centre in Bierutów preliminary study 29. Towne B., et al.: The genetic epidemiology of growth and development. In: Cameron N. Human Growth and development. San Diego, Academic Press, 2006, Woynarowska B. et al.: Standardy WHO Rozwoju fizycznego dzieci w wieku 0-5 lat. Siatki centylowe długości/wysokości i masy ciała, wskaźnika masy ciała BMI i obwodu głowy. Medycyna Wieku Rozwojowego, 2012, XVI, 3: Zadarko-Domaradzka M. et al.: Wpływ czynników społeczno-ekonomicznych na zmienność wysokości i masy ciała dzieci. Przegląd Medyczny Uniwersytetu Rzeszowskiego, 2007, 1: Zaworski B.: Kształtowanie się wybranych cech somatycznych dzieci kaszubskich na tle wpływu warunków społeczno-ekonomicznych ich rodzin. Słupskie prace biologiczne. 2005, 1: ABSTRACT The study was conducted in 27 children (13 girls and 14 boys) aged 8 to 18 years. Measurements were taken on at the care and educational centre in Bierutów. It was a preliminary study beginning a long-term periodic monitoring of the development of children and adolescents. A number of data on somatic traits were gathered and compared to centile charts. For each child or adolescent we calculated a mean centile for length, width and body fatness and presented them in a diagrammatic format. Based on the obtained data children of each sex were divided into 3 groups: with high, low and diversified centile values. The analysis showed alarmingly low values for the traits, which resulted in the immediate referral of two girls and two boys for paediatric check up. The study demonstrated that there was a higher number of boys with low values of the analysed traits when compared to girls. Children and adolescents characterised by low values of length and width, and relatively high body fatness will be carefully monitored during further studies. STRESZCZENIE Badania przeprowadzono u 27 dzieci, w tym 13 dziewcząt i 14 chłopców w wieku od 8 do 18 lat. Pomiary wykonano na terenie placówki szkolnowychowawczej w Bierutowie. Były to badania wstępne rozpoczynające wieloletnią cykliczną kontrolę nad rozwojem badanych dzieci. Zebrano szereg cech somatycznych, które odniesiono do siatek centylowych. Dla każdego dziecka obliczono średni centyl dla cech długościowych, szerokościowych i otłuszczeniowych, oraz przedstawiono je graficznie. W oparciu o uzyskane dane dzieci podzielono w obrębie każdej płci na 3 grupy: o wysokich wartościach centyli, niskich i wartościach zróżnicowanych. Przeprowadzona analiza wykazała niepokojąco niskie wartości cech co skutkowało natychmiastowym skierowaniu dwóch dziewczynek i dwóch chłopców 79

16 HEALTH AND WELLNESS 1/2014 Wellness and team do kontroli pediatrycznej. Wykazano, że chłopcy charakteryzujący się niskimi wartościami badanych cech stanowią liczniejszą grupę w stosunku do dziewcząt. Dzieci charakteryzujące się niskimi wartościami długościowych cech i szerokościowych przy stosunkowo wysokich wartościach wskaźników otłuszczeniowych zostaną poddane wnikliwej obserwacji podczas kolejnych badań. Artykuł zawiera znaków ze spacjami + grafika 80