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PubMed1989

Relationship between maternal and infant nutritional status.

Relationship between maternal anthropometry, age, parity, education, work status, and food practices and nutritional status of children 0-6 months post-partum was determined using a cross-sectional design in a univariate situation. Whereas mothers' weight, height, weight for height, and months of lactation were significantly related to the weight for age of the infants, only weight, height, and work status seemed to affect their height for age. In the second stage where stepwise multiple regression analyses were done, maternal height, months of lactation, and weight for height in that order showed a significant relationship (R2 = 0.08) with infants weight for age while mothers' height and working status were the only two factors that affected the height for age of the infants (R2 = 0.04). The findings suggest that there exists a significant relationship between maternal and child anthropometry.

Adolescent↗
PubMed1996

Safety and efficacy of nandrolone decanoate for treatment of wasting in patients with HIV infection.

OBJECTIVE: To evaluate the safety and efficacy of the anabolic steroid, nandrolone decanoate (Deca Durabolin) in patients with HIV wasting who are resistant to nutritional intervention. DESIGN: A 16-week open trial with subjects who had lost 5-15% of their usual body weight. SETTING: HIV/AIDS specialist ambulatory care services, both public and private, in sydney, Australia. PARTICIPANTS: Two hundred and twenty men entered the pre-therapy phase, and of these, 24 failed to gain weight and were enrolled. Seventeen subjects (81%) completed the 16-week trial. INTERVENTIONS: Pre-therapy nutritional assessment and education was conducted by the clinical dietitian. Those who failed to gain weight (10.9%) were treated with nandrolone decanoate (100 mg/ml) by deep intramuscular injection every 2 weeks for 16 weeks. MAIN OUTCOME MEASURES: Changes in weight and body composition (lean body mass, total body water and nitrogen index) were measured by anthropometry, bioelectrical impedance, and in vivo neutron activation. Changes in quality of life were assessed by the 30-item Medical Outcomes Study short form questionnaire. Changes in biochemistry, haematology and immunology were also measured. RESULTS: There were significant increases in weight (mean, 0.14 kg per week; P < 0.05) and lean body mass (mean, 3 kg by anthropometry; P < 0.005). The change in lean body mass was of similar magnitude across all measurement modalities. Quality of life parameters, especially functionality, increased significantly during the trial. No subject experienced toxicity. CONCLUSION: Nandrolone decanoate has beneficial effects on weight, lean body mass and quality of life in selected patients who have mild to moderate HIV wasting.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Dietary fiber in weaning cereals: a study of the effect on stool characteristics and absorption of energy, nitrogen, and minerals in healthy infants.

We evaluated the effect of increased dietary fiber (DF) content in weaning cereals based on wheat/soy (8.0 and 1.8% DF) and wheat/milk (5.3 and 2.0% DF) in healthy, formula-fed infants 7-17 weeks old. The study had a cross-over design, each infant acting as his or her own control. Stool characteristics and anthropometry were monitored over 4-week periods in groups of 34 (wheat/soy) and 23 (wheat/milk) infants. Absorption of zinc (Zn) and calcium (Ca) was studied by measuring the fecal excretion of stable isotopes during 72 h (70Zn and 42Ca) in a subgroup of the infants consuming wheat/soy cereals. Iron (Fe) bioavailability was evaluated by analysis of the incorporation of 58Fe into erythrocytes 14 days after administration. Fractional absorption (X +/- SD: 8.0 versus 1.8% DF) was 45.3 +/- 27.5 versus 41.2 +/- 19.4% of 70Zn and 63.4 +/- 15.8 versus 64.4 +/- 10.6% of 42Ca. Bioavailability of 58Fe varied between 1.0% and 5.4% (8.0% DF) and from <0.9% to 9.1% (1.8% DF). No significant difference in energy (95.3 +/- 2.0% versus 95.7 +/- 1.2%) or nitrogen (92.6 +/- 2.3% versus 93.0 +/- 1.6%) apparent absorption from the total diet was found during consumption of cereal with 8.0 and 1.8% DF. The intake of cereal decreased with higher DF content in the wheat/soy product: 34 +/- 23 g/d (8.0% DF) versus 42 +/- 23 g/d (1.8% DF), p < 0.01. While consuming the 8.0% DF product, 11 infants were reported to have "gritty stools"; no other differences were observed between different groups in stool characteristics or anthropometry. These results demonstrate no negative effect on the absorption of energy and nutrients with higher dietary fiber intake in primarily formula-fed infants. The impact of increased dietary fiber levels remains unknown in less well-nourished infants.

Aging↗
PubMed1988

Cephalometric and anthropomorphic observations of Binder's syndrome: a study of 19 patients.

Binder's syndrome (maxillonasal dysplasia) is a disorder characterized by nasomaxillary hypoplasia. To ascertain the extent of underdevelopment of the midfacial skeleton and soft tissues, 19 of 29 patients with Binder's syndrome were retrospectively evaluated, both with cephalometry and anthropometry. Ten females and nine males were placed collectively into three age groups: 6 years, 10 years, and 16 to 17 years. Cephalometric measurements disclosed a short anterior cranial base (S-N), a normal length of the vertical maxilla (SE-PNS), a decreased horizontal maxilla (PNS-A, Co-A), a recessed orbitale (SNO), and a high-normal mandibular length (Co-Gn). Anthropometry revealed a large nasofrontal angle, acute nasal inclination and nasolabial angle, decreased nasal prominence (Sn-Prn), a decreased columellar length (C-Sn), and a normal vertical nose (N-Sn) and upper lip (Sn-Sto) length.

Adolescent↗
PubMed2001

Cross-sectional and prospective studies of nutritional indices after percutaneous gastrostomy.

OBJECTIVE: Formal monitoring of nutritional status may be lacking in many patients after gastrostomy. We aimed to study nutritional assessment and its problems in patients after gastrostomy in a cross-sectional study, assess prospectively the changes in nutritional status of patients at 1 month and 6 months after gastrostomy placement, and determine the prognostic value of nutritional indices assessed at the time of gastrostomy placement. DESIGN: We used cross-sectional and prospective cohorts. The subjects were institutional and community patients receiving percutaneous gastrostomy in a teaching hospital. METHOD: We studied patients living in the community and in long-term care institutions after gastrostomy. In the cross-sectional study, we observed all individuals who received a percutaneous gastrostomy from the Gastrointestinal Unit, Western General Hospital, Edinburgh from January 1994 to December 1996. In the prospective study, we observed consecutive referrals of patients to the Gastrointestinal Unit for percutaneous gastrostomy from March 1997 to June 1998. Nutritional status was assessed using: weight (kg), height or stature estimated from knee-height (m), mid-upper arm circumference and triceps skinfold thickness. Body mass index, arm-muscle circumference and corrected arm-muscle area were calculated. A blood sample was taken to assess micronutrient status. RESULTS: In the cross-sectional study, 215 patients were identified who had received a percutaneous gastrostomy during the 3-year period 1994-1996. The weight and height measurements obtained in patients after gastrostomy were not as successful as upper-arm anthropometry. Of the 55 who were alive, traceable and agreed to take part in the study, 8% were under-nourished by corrected arm-muscle area at a median of 16 months after gastrostomy placement, whilst 57% had biochemical evidence of macro- or micronutrient deficiency. In the prospective study, 54 out of 87 patients referred for percutaneous gastrostomy agreed to participate. Using corrected arm-muscle area, 14% of patients were under-nourished at the time of gastrostomy placement. Changes in nutritional status at 1 month and 6 months post gastrostomy were mixed across the patient groups. Patients with a depleted corrected arm-muscle area 21.6 cm2 (log-rank test 9.05; P = 0.003, relative risk 4.7). All patients in whom corrected arm-muscle area had increased at the 1-month follow-up survived to 6 months post gastrostomy. CONCLUSIONS: Assessment of nutritional status may be difficult in gastrostomy-fed patients. Upper-arm anthropometry is more often successful than other assessment methods and gives prognostic information.

Adult↗
PubMed2007

Relation of stavudine discontinuation to anthropometric changes among HIV-infected women.

OBJECTIVE: To characterize changes in regional anthropometry associated with stavudine exposure and discontinuation. DESIGN: Seven hundred thirty-four HIV-infected participants who reported using stavudine (574 of whom later discontinued stavudine) and 698 HIV-uninfected participants from the Women's Interagency HIV Study provided anthropometrics at 8706 semiannual visits between July 1999 and March 2005. METHODS: Changes in weight, waist, chest, upper arm, hip, and midthigh circumferences were evaluated using linear regression with generalized estimating equations. RESULTS: HIV-uninfected women demonstrated increases in regional anthropometry at every body site, whereas HIV-infected women demonstrated decreases in weight and circumferences of the waist, chest, hip, and thigh. A smaller annual decrease in hip circumference was seen after discontinuing stavudine for >2.25 years compared with the decrease observed while on stavudine (P = 0.01). Discontinuing stavudine for >2.25 years was associated with smaller (P < 0.05) decreases in hip (-0.06 cm/y) and thigh (-0.005 cm/y) circumference compared with the decreases observed between 1 and 2.25 years (hip: -0.46 cm/y, thigh: -0.24 cm/y) or < or =1 year (hip: -0.64 cm/y, thigh: -0.27 cm/y) after stavudine discontinuation. CONCLUSIONS: Regardless of continuing or discontinuing stavudine, HIV-infected women demonstrate decreases in weight and body circumference measurements over time. The lower limb seems to be most affected by stavudine exposure, with stabilization observed more than 2 years after discontinuation.

Adult↗
PubMed2004

Is fibre supplementation in paediatric sip feeds beneficial?

The usefulness of a paediatric fibre containing sip feeds specifically formulated for paediatrics has not been evaluated. In an open, prospective, parallel study the efficacy, safety and tolerance of a paediatric fibre-containing sip feed designed for children weighing 8-20 kg (1-6 years) was compared with a fibre-free sip feed in 60 children with chronic illness. The subjects either received a trial sip feed containing 150 kcal (100 ml)(-1) and 2.0 g (100 ml)(-1) of fibre or a fibre-free equivalent control sip feed for 12 weeks. Blood biochemistry, haematology, anthropometry, tolerance and food intake data were estimated during week 1 and 12. The fibre intake was higher (P < 0.0001) and laxative usage decreased in the fibre-containing sip feed group. The sip feed provided almost 50% of fibre intake in the trial group. There were no differences in sip feed tolerance, anthropometry, nutritional biochemistry or haematology between the two groups. Sip feeds provide an important source of fibre for sick children with normal gut function requiring nutritional support.

Anthropometry↗
PubMed2006

The role of prolactin levels in the sexual activity of married men with erectile dysfunction.

OBJECTIVE: To evaluate the effects of risk factors for erectile dysfunction (ED) including anthropometry, hormones, metabolic profiles and lifestyle, on sexual activity in married men with ED. PATIENTS AND METHODS: The study included 261 men (mean age 53.7 years, range 23-80), who were evaluated for anthropometry, hormone levels, metabolic profiles and lifestyle factors. Erectile function was evaluated using the self-administered International Index of Erectile Function. Patients were classified into two groups based on the six-item erectile-function domain, as those with sexual activity and those without. RESULTS: Of all patients, 62.5% (163 of 261) had no sexual activity (erectile-function domain score <6). There was a significant difference in mean (sem) prolactin level between patients with and with no sexual activity, at 4.8 (0.4) vs 6.8 (0.7) (P = 0.013). Of all patients, 73.7% (42 of 57) with diabetes had no sexual activity, while 59.3% (121 of 204) without diabetes had (P = 0.048). In a multivariate model, a higher prolactin level was associated with a greater likelihood of sexual inactivity (odds ratio 1.094; 95% confidence interval, 1.010-1.185; P = 0.028) but diabetes lost its statistical significance. The area under the receiver-operating characteristic curve for prolactin was 60.5% (95% confidence interval, 52.9-68.1%; P = 0.009) for sexual inactivity. No other factors were significant in this regard. CONCLUSION: Our findings suggest that prolactin levels might play a role in sexual activity in men with ED.

Adult↗
PubMed1999

Prevalence and socio-demographic predictors of dietary goal attainment in an older population.

OBJECTIVE: To describe the measured dietary intakes and anthropometry of a large, free-living population of middle-aged and older Australians who participated in the Australian Blue Mountains Eye Study (BMES), and to identify the socio-demographic characteristics associated with attainment or non-attainment of dietary goals. METHOD: Anthropometry and dietary intakes were compared with current population dietary goals and Recommended Dietary Intakes for 2,873 people (79% of eligible residents) aged > or = 49 years who participated in the BMES. Nutrient intakes were measured by a validated food frequency questionnaire. RESULTS: Nutrients for which mean intakes deviated most from nutrition goals included: percentages of energy from total and saturated fat, carbohydrate and alcohol (men), as well as absolute intakes of calcium, zinc and fibre. More than half the men (60%) and women (54%) were overweight or obese. Several micro-nutrient goals were more likely to be met in households where the respondents and/or their spouses were independent. Married men were more likely to meet goals for fibre and iron, but less likely to meet the goal for cholesterol. Several goals were more likely to be met by men and women who had qualifications after leaving school, those with higher job status and non-pensioners, suggesting an socio-economic status dimension. CONCLUSIONS AND IMPLICATIONS: These results indicate that over- rather than under-nutrition is more prevalent among community-dwelling older people, although under-nutrition should not be overlooked. Particular sub-groups that are less likely to meet some dietary goals may require targeting in community nutrition interventions.

Age Distribution↗
PubMed2004

Postpartum maternal moods and infant size predict performance on a national high school entrance examination.

BACKGROUND: In an earlier series of studies, we documented the effects of feeding practices and postnatal maternal mood on the growth and development of 226 Barbadian children during the first few months of life. In this report, we extend our earlier studies by examining predictive relationships between infant size, feeding practices and postpartum maternal moods and scores on a national high school examination, the Common Entrance Examination (CEE), at 11 to 12 years of age. METHODS: Feeding practices, anthropometry, and maternal moods, using Zung depression and anxiety scales and a morale scale, were assessed at 7 weeks (n = 158), 3 months (n = 168), and 6 months (n = 209) postpartum. Background variables including sociodemographic and home environmental factors were also assessed during infancy. CEE scores on 169 of the children in the original study were obtained from the Ministry of Education of Barbados. RESULTS: In our sample of 86 boys and 83 girls, we found that reduced infant lengths and weights at 3 and 6 months of age were predictive of lower CEE, especially math scores. Children who were smaller at these early ages had significantly lower scores on the examination than did larger children. Postpartum maternal moods, including reports of despair and anxiety, were also found to be significant predictors of lower CEE scores, especially English scores. However, breast-feeding and other feeding practices were not directly associated with the CEE scores. Background variables, which significantly predicted lower CEE scores, included young maternal age at the time of her first pregnancy, more children in the home, less maternal education, and fewer home conveniences. Significant associations between infant anthropometry, maternal moods and CEE scores were all significant even when these background variables were controlled for. CONCLUSIONS: These findings have important implications for developing interventions early in life to improve academic test scores and future opportunities available to children in this setting.

Achievement↗
PubMed1991

Aspects of anthropometric evaluation of malnutrition in childhood.

The evaluation of malnutrition by the use of anthropometry poses considerable problems if any meaningful information is to be acquired, particularly on individual children. It is possible to formulate reference values (17), for height and weight taking age into account, or perhaps as a simple ratio but there may be little relation between the assessment of malnutrition by this means and functional impairment. It is suggested in this paper that anthropometry in this context should include length or stature, weight, skinfold thicknesses (triceps, subscapular and suprailiac) and circumferences (head, upper arm, upper thigh). The reference values to be used in the assessment of malnutrition are not very satisfactory, and there are objections to the simple use of the NCHS (9) data. It would be more desirable to use values obtained on "well-fed" indigenous populations, although these hardly exist at the present time. Well-controlled surveys are urgently needed on length or stature, weight, skinfolds, and circumferences of appropriate populations if anthropometric evaluation of malnutrition is to be anything other than a crude assessment. At a more complex level, the relationship of these anthropometric variables to various functional tests also needs investigation.

Anthropometry↗
PubMed1996

Maternal smoking and body composition of the newborn.

The influence on neonatal anthropometry of maternal cigarette smoking in pregnancy was investigated in 933 parous women. Anthropometric growth parameters including skinfold measurements were studied in the newborns. After adjustment for maternal age, pre-pregnancy weight, height and pregnancy weight gain, smoking had a clear dose-dependent negative effect on all anthropometric characteristics in the infant. In contrast to the results obtained in other investigations, the reduced birth weight of the infants of smoking mothers was not found to be primarily due to a reduction in lean body mass; nor was fat deposition found to be reduced. Fetal anthropometry was also negatively affected in infants born to mothers who stopped smoking during pregnancy.

Adult↗
PubMed1997

Nutritional impact of antipseudomonas intravenous antibiotic courses in cystic fibrosis.

OBJECTIVE: To evaluate the short term effects on nutritional status of home intravenous anti-pseudomonas antibiotic courses in cystic fibrosis (CF) patients chronically colonised with Pseudomonas aeruginosa. DESIGN: A prospective study involving 38 CF patients, mean age 10.9 (SD 4.3) years (range 4.3 to 22.2 years), presenting with pulmonary exacerbations of P aeruginosa infection. The patients received a 14 day antibiotic course of intravenous ceftazidime (200 mg/kg/day) and either amikacin (35 mg/kg/day) or tobramycin (15 mg/kg/day). Nutritional evaluation on days 1 and 14 involved measurements of weight, weight/height ratio (per cent of predicted value), energy intake (per cent of recommended daily allowances), serum prealbumin, and body composition assessed by two methods: bioelectrical analysis (BIA) and skinfold anthropometry. The non-parametric Wilcoxon t test was used for statistical analysis, with a Bland-Altman plot to assess the degree of agreement between the two methods of evaluating body composition. RESULTS: Weight increased by 1.0 (0.8) kg (p < 0.001); weight/height increased from 94.4(12.2)% to 98(12.7)% (p < 0.001), energy intake from 107(32)% to 119(41)% (p < 0.02), and prealbumin from 183 (63) to 276 (89) mg/l (p < 0.001). Fat mass increased by 0.8 (1.0) kg (p < 0.001), without any significant change in fat-free mass. The limits of agreement between BIA and anthropometry were -0.7 kg and +1.1 kg. CONCLUSIONS: Antibiotic courses allow an improvement in nutritional status in CF patients, with a gain in fat mass.

Adolescent↗
PubMed1995

The New Zealand rugby injury and performance project. III. Anthropometric and physical performance characteristics of players.

OBJECTIVE: To investigate the anthropometric and physical performance characteristics of New Zealand rugby players of different ages and both sexes. METHODS: 356 rugby players (264 male, 92 female) took part in the study during a single season. Playing grade ranged from schoolboys and schoolgirls to senior men and women. Assessment of height, weight, neck circumference, and somatotype was performed before the competitive rugby season. A battery of six physical performance assessments was completed after the anthropometry. Analysis of variance was used to examine differences in these variables between field positions and grades. RESULTS: Significant differences between forwards and backs on anthropometric and physical performance variables were apparent at all grades assessed. In terms of anthropometric characteristics, forwards of a given grade were generally taller, possessed greater body mass, and were more endomorphic and less ectomorphic than backs of the same grade. The backs tended to perform better on physical performance measures than forwards, being more aerobically fit, faster, more agile, and possessing a higher degree of muscular endurance. Differences in anthropometry and physical performance attributes were also apparent between players from the various grades. The players at higher levels were generally larger, and performed better on tests of physical performance than the players at lower levels. These differences were found in both sexes. CONCLUSIONS: The greater body mass of the forwards allows them to obtain greater momentum than the backs when sprinting. The ability to obtain greater momentum is important in the body contact phases of the game. Forwards may compromise their aerobic fitness and speed to some extent in order to maintain a high body mass. The anthropometric and physical performance characteristics of players appear to reflect the demands placed on them by the sport.

Adolescent↗
PubMed2003

Obesity indices and major components of metabolic syndrome in young adult Arab subjects.

BACKGROUND: The major components of metabolic syndrome are atherogenic dyslipidaemia (AD) and insulin resistance (IR), and both predict risk for atherosclerotic cardiovascular disease even in healthy individuals. AIMS: To assess if, in a group of healthy young adult Arab subjects, a simple classification in high and normal scores on waist-hip ratio (WHR), body mass index (BMI) and waist circumference (WC) scales could predict atherogenic parameters for metabolic syndrome (AD, IR). SUBJECTS AND METHODS: The subjects [n = 177 (72 M, 105 F), aged 29.7 +/- 8.4 (SD) years], underwent physical evaluation, BP measurement and anthropometry [height (m), weight (kg), waist (WC) and hip circumference (HC, cm)]. The cut-off points for normal/high scores on the indices were: (1) BMI: 30 kg/m(2) (M and F); (2) WHR: 0.80 F, 0.95 M, and (3) WC: 90 cm F, 100 cm M). The biochemical indices measured on fasting serum were: (1) AD: total cholesterol (TC), triglycerides (TG), HDL, LDL, apo B, HDL/TC ratio, and (2) IR: insulin, urate, insulin/glucose ratio (IGR). RESULTS AND DISCUSSION: In the whole group of subjects, and in women separately considered, those with high indices (BMI, WHR, WC) had significantly increased levels of glucose, LDL, apo B, urate, mean BP, TG, insulin and IGR and lower values for HDL/TC ratio (all p < 0.05). In men, only urate, insulin and IGR levels were increased (p < 0.01) in the high-score groups. None of the indices showed any special superiority in describing the risk of AD or IR. CONCLUSION: In women, BMI, WHR and WC appeared equally good in identifying individuals at high risk of AD and IR while in men, these indices satisfactorily described the risk of IR but not of AD. It is important to re-emphasise the need to indicate gender distinctions in using anthropometry for CHD risk assessment.

Adult↗
PubMed1997

The measurement of neonates.

Accurate measurements of both healthy and premature neonates are possible but rarely performed. Routine anthropometry is often not performed at all or with large measurement errors due to inadequate training of personnel or inappropriate equipment. Sick neonates are often considered unsuitable for anthropometry and growth is wrongly equated with weight gain. Gain in length may be disturbed by poor health and permanent extrauterine growth retardation and changes in body proportions induced in some survivors of neonatal intensive care. Drug treatments may have profound effects on length gain and the relationship of length to weight.

Anthropometry↗
PubMed2006

Maternal and neonatal influences on, and reproducibility of, neonatal aortic pulse wave velocity.

Aortic pulse wave velocity (aPWV), a noninvasive measure of vascular stiffness, is an independent predictor of cardiovascular disease both before and in overt vascular disease. Its characteristics in early life and its relationship to maternal factors have hardly been studied. To test the hypothesis that infant aPWV was positively related to maternal anthropometry and blood pressure (BP) at 28 weeks gestation, after adjusting for neonatal anthropometry and BP, 148 babies born in Manchester were measured 1 to 3 days after birth. A high reproducibility of aPWV, assessed in 30 babies within 3 days of birth, was found with a mean difference between occasions of -0.04 m/s (95% CI: -0.08 to 0.16 m/s). Contrary to our hypothesis, a significant inverse relation was found between neonatal aPWV (mean: 4.6 m/s) and maternal systolic BP (mean: 108.9 mm Hg; r=-0.57; 95% CI: -0.67 to -0.45) but not maternal height nor weight. Neonatal aPWV was positively correlated with birth length, birth weight, and systolic BP. In multiple regression, neonatal aPWV remained significantly inversely associated with maternal systolic BP (adjusted beta coefficient: -0.032; 95% CI: -0.040 to -0.024; P<0.001), after adjustment for maternal age, birth weight, length, and neonatal BP (all independently and positively related to aPWV) and for gestational age, maternal weight, and height (unrelated). These results suggest that infant aPWV may be a useful index of infant vascular status, is less disturbing to measure than infant BP, and is sensitive to the gestational environment marked by maternal BP.

Adult↗
PubMed1996

A study of intrinsic factors in patients with stress fractures of the tibia.

We aimed to study intrinsic factors in 29 consecutive patients with well-documented unilateral stress fractures of the tibia. Anthropometry, range of motion, isokinetic plantar flexor muscle performance, and gait pattern were analyzed. The uninjured leg served as the control. A reference group of 30 uninjured subjects was compared regarding gait pattern. Anterior stress fractures of the tibia (N = 10) were localized in the push-off/ landing leg in 9/10 athletes, but were similarly distributed between legs in posteromedial injuries (N = 19). Ten (30%) of the stress fracture subjects had bilateral high foot arches, similar to those found in the reference group. There were no other systematic differences in anthropometry, range of motion, gait pattern, or isokinetic plantar flexor muscle peak torque and endurance between injured and uninjured legs. No other differences were found between anterior and posteromedial stress fractures. We conclude that anterior stress fractures of the tibia occur mainly in the push-off/landing leg in athletes. Within the limitations of our protocol, no registered intrinsic factor was found to be directly associated with the occurrence of a stress fracture of the tibia.

Adolescent↗