Biomedical subjects
J M Tanner
Publications and source records attributed to J M Tanner.
Ecological considerations in the creation and the use of child growth standards.
There is no proper substitute for a country, especially a developing country, having its own child growth standards or norms for clinical use, based on a representative sample of the population. Separate standards may be derived for subgroups of the population, but the application to the whole population of standards based on an economically privileged group is inappropriate, as is the use of an international standard. The screening or clinical use of growth standards should be sharply distinguished from the use of growth measurements to compare disadvantaged with privileged groups or populations. In particular, the use of growth standards to screen individual children should not divert attention from the need to change existing differences between disadvantaged and privileged groups.
Growth in height compared with advancement in skeletal maturity in patients treated with human growth hormone.
Height growth and skeletal maturation were compared in 201 patients treated for between 1 and 15 years with growth hormone (GH) supplied by the Medical Research Council. 107 patients had isolated GH-deficiency, 30 had panhypopituitarism, and 64 craniopharyngiomata. The mean rate of skeletal maturation did not differ between the first year and the total period of treatment, averaging 1 'year'/year in the patients with isolated GH-deficiency or panhypopituitarism, and 0.6 'years'/year in those with craniopharyngioma. No association was observed between the rate of skeletal maturation and the bone age or the bone age deficit (chronological minus bone age) at the start of treatment. Mean height standard deviation score for bone age was negative in all three diagnostic groups at the start of treatment, but became less negative as treatment progressed in patients with isolated GH-deficiency or craniopharyngioma. In patients with panhypopituitarism there was no significant change in height standard deviation score for bone age as a result of treatment. The findings do not support the suggestion that treatment with GH(UK) causes ultimate stunting due to greater osseous maturation than growth in height.
Experience with human growth hormone in Great Britain: the report of the MRC Working Party.
The Working Party on human growth hormone (hGH) has during the past decade developed a system for the evaluation and treatment of patients suffering from hGH lack. Today there are nineteen measurement centres in the United Kingdom at which patients are assessed and where the effects of therapy are monitored. The current supply of hGH, which is prepared from pituitary glands collected by pathologists in the National Health Service, is just enough to meet demand, but research conducted on behalf of the Working Party suggests that hGH deficiency is more common than has been thought and that the prevalence may be as high as one in 10 000. If, as is hoped, patients are diagnosed younger and more patients with partial deficiency are recognized, demand may soon outstrip supply. Work is in progress to define better methods of hGH production and optimal dose regimens, both of which will help to minimize the problem of supply and demand. A few children have anti-hGH antibodies, which block growth as a result of treatment. Improved hGH production techniques may result in a less antigenic product and the resolution of this problem. Many of the Working Party's activities began as research and have evolved into service. Because of this shift in emphasis, and although much research is still to be done, responsibility for provision of treatment with hGH transferred from the Medical Research Council to the Department of Health and Social Security in July 1977.
Prediction of the timing of the adolescent growth spurt from ossification events in hand-wrist films.
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A correction to the TW2 RUS-based tables for predicting adult height.
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A correction to the TW2 RUS-based tables for predicting adult height.
An error in the table for predicting the adult height of girls from RUS bone age, height and age, is identified and corrected.
A longitudinal radiographic study of the growth of the rat skull.
The growth of the skull of the rat was longitudinally from 23 to 140 day PC from radiographs. Four measurements were made on each animal at each age studied. The velocity graphs of these measurements showed that for two, namely neurocranium length and bizygomatic width, the peak rate of growth occurred before birth. Viscerocranium length and neurocranium width showed peak rates after birth. Males became significantly larger than females in each of the absolute measurements studied, but in cranial index and facial index there were no significant differences between the sexes. Both these indices showed strain differences when compared to the results obtained by other workers.
On the selection of patients for treatment of growth failure with hGH.
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Aetiology of idiopathic growth hormone deficiency in England and Wales.
Information on height, sex, age, and condition of mothers' pregnancy and labour was obtained on all first- and second-degree relatives of 140 cases of idiopathic growth hormone deficiency (GHD). Less detailed information was available for 68 further cases, the two samples together constituting all cases from England and Wales treated under the Medical Research Council Clinical Trial of Human Growth Hormone up till 1974. Compared with the Perinatal Mortality survey of 1958, idiopathic GHD cases showed a significantly greater incidence of breech births (13-7%), of forceps deliveries especially in multiparae (5-6%), and of reported early vaginal bleeding (7-1%). The incidences of breech and forceps were both higher in cases with multiple pituitary hormone deficiency than in cases of 'isolated' GHD. The frequency of either breech or forceps was 43% in multiple and 20% in 'isolated' GHD. Heights of fathers and sibs of affected cases averaged the 50th centile; those of mothers the 35th centile. The ratio of boys to girls affected was 3-8. There were 4 families with more than one member affected; 4-5% of the brothers of probands were themselves affected, 2% of fathers and 1-5% of both sisters and mothers. In the world literature the sex ratio averages about 2-9 with little difference between series; the frequency of breech delivery averages 21% with large differences (2% to 50%) between series. A table of relative risks is given from which a screening procedure may be constructed; following 1% of selected births would give 10% of cases, and 20% of births 50% of cases. We propose a multifactorial aetiology for GHD which brings it into line with malformations such as anencephaly, cleft lip and palate, and pyloric stenosis. An underlying liability to the disease is postulated, continuously distributed in the population and depending on both polygenic and environmental factors among which sex and birth trauma are important. The disease becomes manifest when the liability value reaches a fixed threshold. On this assumption, heritability of idopathic GHD is approximately the same as that of coeliac disease, pyloric stenosis, and patent ductus.
Cartilage hair hypoplasia.
Six cases of cartilage hair hypoplasia from five kindreds are described. They demonstrate variation in the expression of clinical features such as sparsity of hair, hair calibre, radiological changes, short stature and the extent of the disproportion between sitting height and stature.
Results of intermittent treatment of growth hormone deficiency with human grwoth hormone.
The growth in stature of two groups of growth hormone deficient children has been compared. The frist group received intermittent treatment with human Growth Hormone (hGH), 1 year on, 1 year off, subsequent years on; the second group received continous treatment. This latter group had a significantly better mean growth response. The reduction in treatment velocity in years subsequent to the first was not prevented by the year off treatment, the mean velocity of the intermittent group in their 3rd year being the same as that of the continous group in their second. We conclude that intermittent hGH therapy is of less values than continous treatment and should be avoided, at least pending further evidence.
Comparative rapidity of response of height, limb muscle and limb fat to treatment with human growth hormone in patients with and without growth hormone deficiency.
The widths of muscle and fat in the upper arm and calf have been measured radiologically before treatment and at intervals of 1, 3. 6 and 12 months during administration of human growth hormone in 41 pre-pubertal patients with "isolated" growth hormone deficiency and in 22 patients with multiple deficiencies following gross CNS lesions. Height was also measured. The curves of response of muscle and fat on the one hand and height on the other were strikingly dissimilar. A very rapid increase of muscle took place in the first month; but after 6 months the increments had fallen to normal values for size and bone age. Decrements in fat followed the same pattern. Height, however, showed a smaller increment in the first month than in the period 1 to 3 months in the "isolated" deficiency cases, and much slower fall back towards normal. The first-year height increment was not at all correlated with the first-month height increment in the "isolated" deficiency cases, though it had a correlation coefficient of 0.46 with the first-month muscle increment. Nine cases of short stature not due to GH deficiency were similarly studied. There was considerable overlap between deficient and non-deficient in all responses in the first 3 months, though children in the top half of the responder's distribution could be distinguished. A 1-month radiological test of responses to hGH in doubtful cases is proposed, using in all only 40 IU of hormone. It is emphasised that a small response of muscle and fat may occur in cases who do nevertheless respond in height to hGH administration; a large response in muscle and fat, however, is indivative that treatment will be effective, though it does not well predict the precise amount of height that may be gained.
The presentation and use of height and weight data for comparing the nutritional status of groups of children under the age of 10 years.
This paper presents recommendations for the analysis and presentation of height and weight data from surveillance or surveys involving nutrition and anthropometry in young children up to the age of 10 years. These recommendations are only for the analysis of data collected on a cross-sectional basis. The basic indices recommended are height for age and weight for height, each considered either in terms of centiles or in a cross-classification scheme using standard deviation scores. It is hoped that these methods of analysis and presentation will prove widely acceptable, so that international comparisons will be made easier.
Relationship of radial metaphyseal band width to stature velocity.
A relatively radiodense metaphyseal band is present at the distal end of the radius in normally growing children. The width of this band is related to the velocity of stature growth. Though individual growth rates in height cannot be closely predicted from the width of the band in normal children and adolescents, in certain clinical conditions the band width may be a useful guide as to whether or not growth is proceeding normally. Examples are given of the effect of human growth hormone treatment on the band width in a case of isolated growth hormone deficiency and of the effect of thyroid treatment on the band width in a case of hypothyroidism.
Relative importance of growth hormone and sex steroids for the growth at puberty of trunk length, limb length, and muscle width in growth hormone-deficient children.
We have followed the growth of stature, sitting height, skinfolds, muscle widths measured radiologically, and skeletal maturity in growth hormone-deficient patients in whom hGH was given and withheld in alternating three-month periods throughout puberty (referred to as "off-hGH" and "on-hGH" periods). Six boys and four girls had true isolated GH deficiency and developed puberty spontaneously. Two boys had gonadotrophin deficiency plus GH deficiency, and five boys had multiple deficiencies; in these boys the signs of puberty were induced by hormone treatment. Boys with true isolated deficiency grew about two-thirds as much in height in the off-hGH periods as in the on-hGH periods; their total gain in height during the adolescent spurt would have been about 20 cm, instead of 30 cm, if hGH had been discontinued at the beginning of puberty. The effect of hGH was entirely on growth in leg-length, however, which virtually ceased during the off-hGH periods. Growth in sitting height altered little when hGH was withdrawn. Growth in limb muscles, however, was GH dependent throughout puberty; during the majority of periods when hGH was withheld, muscle was actually lost; this occurred in the boys who were receiving large doses of testosterone as well as in those producing their own normal amounts. Subcutaneous fat diminished when hGH was given and increased when it was withdrawn; this occurred independently of administration of testosterone. There was little evidence that growth of pubic and axillary hair progressed faster during on-hGH periods, except perhaps in patients with multiple deficiencies. There was some evidence, however, that bone age progressed less rapidly during on-hGH periods than during off-hGH periods in the patients with isolated deficiency. The results in the girls agreed with those in boys so far as stature was concerned, but the relationship with sitting height and leg length appeared to be different; the reasons for this are discussed. We conclude that all children with GH deficiency should continue on treatment with hGH throughout puberty, ideally until growth ceases.
Growth as a monitor of nutritional status.
1. Methods of monitoring growth of individuals in a population, and average growth in height and other measurements of populations or subpopulations must be distinguished. 2. Individual monitoring of nutritional status should be by growth velocity charts, for height, chiefly, and weight, if interpreted correctly. Growth velocity may be reduced by psychological stress; it monitors a total micro-ecological situation, not just a nutritional one. 3. Population monitoring requires defined and repeated samples. The secular trend and the differences in height for age and in age at menarche related to occupational class and number of siblings reflect nutritional differences, but only as part of the same micro-ecology. Height for age and weight-for-height-irrespective-of-age have been recommended as monitors, especially for populations in developing countries. The latter poses methodological problems and is probably only legitimate between the ages of 1-0 and 9-9 years.
The adolescent growth spurt of boys and girls of the Harpenden growth study.
Logistic curves have been fitted to the growth during puberty of the 55 boys and 35 girls of the Harpenden Growth Study who were measured every three months during puberty and thereafter until growth ceased. Very good fits were obtained for stature, sitting height, subischial leg length, biacromial and bi-iliac diameters from approximately six months after the beginning of the adolescent spurt. This beginning, called "take-off", was determined graphically as the point of minimum velocity. The total height gained from take-off point to cessation of growth averaged 28 cm in boys and 25 cm in girls with standard deviations of about 4 cm. The adult sex difference in height was due much more to the later take-off in boys than to a greater male adolescent spurt. A sex difference in the spurt occurred in sitting height but not in leg length. Mean-constant curves for the four measurements are presented. In each measurement size at take-off and total adolescent gain were nearly independent, the average correlation coefficient being --0-2. The correlations between adolescent gains in different measurements averaged only 0-47, and between peak velocities of different measurements only 0-27. This implies considerable shape change at adolescence. In contrast the average correlation between ages at which the peak velocities were reached was 0-87. Ages at take-off, at peak velocity, and at menarche were independent of mature size, though correlated with percentage of adult size reached at the ages in question, a measure of somatic maturity. Relationships with the development of breasts, pubic hair and genitalia were examined; ages at take-off and at peak velocity correlated to the extent of 0-6 to 0-8 with ages of B2 and PH2 but both these parameters and also peak velocities were uncorrelated with the rapidity with which sex characters developed.